Author + information
- Varinthrej Dhiantravan,
- Jignesh Patel,
- Michelle Kittleson,
- Matthew Rafiei,
- Ashley Osborne,
- David Chang,
- Lawrence Czer and
- Jon Kobashigawa
Skin cancer is the most common malignancy after heart transplant (Htx). It is common belief that azathioprine (AZA) may be more carcinogenic, thus patients have been switched to other antiproliferative drugs. It has not been well established which immunosuppression (IMS) regimen contributes to the development of this malignancy.
Between 1994 and 2007, we reviewed 930 Htx patients and found 92 (10%) Htx patients who developed various forms of skin cancer. These patients were divided into specific skin cancers including basal cell, squamous cell, melanoma, others. Furthermore, patients were subdivided into those that received cyclosporine (CSA)/AZA, CSA/mycophenolate (MMF), and tacrolimus (TAC)/MMF IMS. 10 year actuarial outcomes were recorded.
In the 92 patients with skin cancer, squamous cell cancer was the largest group (70%). Most patients responded to local excision; however, 3% required chemotherapy. The average time to onset of skin cancer was 7.4 ± 3.9 years and the average age of patients developing skin cancer was 67.2 ± 9.4 years. CSA/AZA treated patients had the least incidence of skin cancer and least amount of squamos cell cancer (see table).
Contrary to popular belief, CSA/AZA appears to have the least association with the development of skin cancer compared to CSA/MMF and TAC/MMF. Previous change in IMS away from AZA for skin cancer may merit a paradigm change.
|Outcome||CSA/AZA (N = 20)||CSA/MMF (N = 32)||TAC/MMF (N = 40)|
|Incidence of Skin Cancer, n (%)||20/294 (7%)||32/278 (12%)†||40/358 (11.2%)‡|
|Squamous Cell, n (%)||9/13 (69%)||17/22 (77%)||7/12 (58%)|
|Mean Time to Skin Cancer, Years ± SD||9.1 ± 4.6||7.8 ± 4.1||6.2 ± 2.5*|
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Challenges and Clinical Outcomes in Cardiac Transplantation
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1309-305
- 2013 American College of Cardiology Foundation