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1.
Arch Dermatol ; 146(3): 294-9, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20231501

ABSTRACT

OBJECTIVE: To compare the long-term risk of primary nonmelanoma skin cancer (NMSC) and the risk of subsequent NMSC in kidney and heart transplant recipients. DESIGN: Partially retrospective cohort study. SETTING: Two Italian transplantation centers. PATIENTS: The study included 1934 patients: 1476 renal transplant recipients and 458 heart transplant recipients. MAIN OUTCOME MEASURES: Cumulative incidences and risk factors of the first and subsequent NMSCs. RESULTS: Two hundred patients developed a first NMSC after a median follow-up of 6.8 years after transplantation. The 3-year risk of the primary NMSC was 2.1%. Of the 200 patients with a primary NMSC, 91 (45.5%) had a second NMSC after a median follow-up after the first NMSC of 1.4 years (range, 3 months to 10 years). The 3-year risk of a second NMSC was 32.2%, and it was 49 times higher than that in patients with no previous NMSC. In a Cox proportional hazards regression model, age older than 50 years at the time of transplantation and male sex were significantly related to the first NMSC. Occurrence of the subsequent NMSC was not related to any risk factor considered, including sex, age at transplantation, type of transplanted organ, type of immunosuppressive therapy, histologic type of the first NMSC, and time since diagnosis of the first NMSC. Histologic type of the first NMSC strongly predicted the type of the subsequent NMSC. CONCLUSIONS: Development of a first NMSC confers a high risk of a subsequent NMSC in transplant recipients. Intensive long-term dermatologic follow-up of these patients is advisable.


Subject(s)
Organ Transplantation/adverse effects , Skin Neoplasms/epidemiology , Adult , Aged , Female , Follow-Up Studies , Heart Transplantation/adverse effects , Humans , Incidence , Italy/epidemiology , Kidney Transplantation/adverse effects , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors , Sex Factors , Skin Neoplasms/diagnosis , Skin Neoplasms/etiology , Time Factors , Young Adult
2.
Clin Transplant ; 24(3): 328-33, 2010.
Article in English | MEDLINE | ID: mdl-19712084

ABSTRACT

BACKGROUND: Primary opportunistic deep cutaneous fungal infections may cause significant morbidity and mortality in solid organ transplant recipients (OTR), but no data exist about their incidence, timing, and clinical predictors in a long-term follow-up. PATIENTS AND METHODS: A series of 3293 consecutive OTR including 1991 kidney, 929 heart, and 373 liver transplant recipients were enrolled. Patients were regularly followed up since time at transplantation (mean 5.5 yr +/-5.9 SD) and primary opportunistic fungal infections registered. Persons-year at risk (PYs), incidence rates (IR), incidence rate ratios (IRR), and 95% confidence intervals were computed. RESULTS: Twenty-two cases of deep cutaneous mycoses were detected, (IR 1.2 cases per 1000 PYs) after a mean follow-up time since transplantation of 2.5 yr +/- 2.0 SD (median 1.8 yr). Six patients had subsequent systemic involvement and three patients died of systemic dissemination. A higher risk for mycoses was observed in the first two yr after transplantation, (IRR 35.9, p < 0.0001), in renal transplant recipients (IRR 5.1 p = 0.030), and in patients transplanted after the age of 50 (IRR 11.5 p = 0.020). CONCLUSIONS: Primary deep cutaneous opportunistic mycoses in OTR occur mainly in the first two yr after transplantation, in renal transplant recipients, and in older patients.


Subject(s)
Dermatomycoses/epidemiology , Heart Transplantation , Kidney Transplantation , Liver Transplantation , Opportunistic Infections/epidemiology , Adult , Cohort Studies , Dermatomycoses/diagnosis , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Opportunistic Infections/diagnosis , Prognosis , Retrospective Studies , Risk Factors
3.
Dermatology ; 219(2): 133-7, 2009.
Article in English | MEDLINE | ID: mdl-19546510

ABSTRACT

BACKGROUND: A predictive model may help to select likely responders and to anticipate treatment duration in vitiligo. METHODS: We aimed to develop a predictive rule based on data from a randomized trial of excimer laser in vitiligo. Information on 325 treated patches was available. The degree of repigmentation was assessed by digital image analysis of UVB-reflected photographs. Since no strong relationship between any single predictive parameter and outcome was initially documented, we relied on artificial neural networks. RESULTS: Using a time-response optimal threshold model, data were divided into 2 groups of responders and nonresponders. A discriminant network was trained in order to detect responders versus nonresponders. A regression network was subsequently used to compute repigmentation time in responders. The neural network discriminator achieved 66.46 +/- 5.37% (95% CI) overall accuracy. The mean absolute error of the neural network regressor was 19.5843 +/- 2.0930 with a root mean square error of 23.7156 +/- 2.2225. CONCLUSION: Our study offers insight into the difficulty of clinical prediction in vitiligo and presents a way to develop an instrument with which to predict the clinical time response in patients treated by excimer laser.


Subject(s)
Lasers, Excimer/therapeutic use , Low-Level Light Therapy/methods , Neural Networks, Computer , Vitiligo/radiotherapy , Adult , Female , Humans , Male , Middle Aged , Patient Satisfaction , Predictive Value of Tests , Risk Assessment , Severity of Illness Index , Treatment Outcome , Vitiligo/pathology
6.
Eur J Dermatol ; 16(5): 553-7, 2006.
Article in English | MEDLINE | ID: mdl-17101478

ABSTRACT

Kaposi's sarcoma (KS) can be a complication of solid organ transplantation, but with an important incidence rate variability in different geographical areas. Here we analyzed the incidence rate, timing and clinical correlates of KS, in a cohort of Italian solid organ transplant recipients from four distinct transplantation centers. A total of 1721 renal, heart and liver transplant recipients were recruited between 1997 and 2004. KS was diagnosed in 40 patients, after a median follow up of 1 year (range 0.8-5.1). Visceral involvement was detected in 7/40 patients. Incidence rate of KS in the whole population was 2.3 cases per 1000 individuals per year. The standardized incidence rate (SIR) for KS in renal transplant recipients was 149.9 (95% CI 103.0-212.0), with the excess risk greater among women (SIR 316.0) than among men (SIR 133.6). In a Cox proportional hazard regression model, age at transplantation equal or older than 30 years and only combined immunosuppressive therapy with mycophenolate mofetil + cyclosporine + prednisolone were independently associated with KS. Italian organ transplant recipients have an increased risk (about 100 times greater) for KS compared to the general population, especially during the first two years after transplantation. Age older than 30 years at transplantation and a more aggressive immunosuppressive regimen were both independent risk factors for the disease.


Subject(s)
Immunosuppression Therapy/statistics & numerical data , Organ Transplantation/statistics & numerical data , Sarcoma, Kaposi/epidemiology , Adult , Cohort Studies , Female , Humans , Immunosuppression Therapy/adverse effects , Incidence , Male , Middle Aged , Organ Transplantation/adverse effects , Proportional Hazards Models , Risk Factors , Sarcoma, Kaposi/etiology
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