Skip to main content
SpringerLink
Log in

Hauttumoren nach Organtransplantation

Eine interdisziplinäre Herausforderung

Skin tumors after organ transplantation

An interdisciplinary challenge

  • Leitthema
  • Published:
Der Nephrologe Aims and scope

Zusammenfassung

Eine der größten Herausforderung der Transplantationsmedizin war und ist die Kontrolle von Abstoßungsreaktionen. Die medikamentöse Inhibition der zellulären Immunüberwachung führt jedoch besonders an der Haut zu einer signifikanten Zunahme von Neoplasien. Invasive Plattenepithelkarzinome sind die am häufigsten diagnostizierten Malignome bei Organtransplantierten und können durch ihr multifokales Auftreten sowie das aggressive Wachstum eine Bedrohung für immunsupprimierte Patienten darstellen. Interdisziplinäre Nachsorgeprogramme basieren auf den epidemiologischen Analysen individueller dermatologischer Risikofaktoren für die Hauttumorgenese wie Alter, Hauttyp, Sonnenexposition sowie Art und Dauer der Immunsuppression. Neben Aufklärungsprogrammen und einer kausal orientierten Primärprophylaxe (Sonnenschutz) sowie der Verwendung einer risikoadaptierten Immunsuppression hat sich das proaktive Management präinvasiver Hauttumoren durch moderne Flächentherapien bewährt. Die am Beispiel der Organtransplantierten etablierten interdisziplinären Konzepte und Versorgungsstrukturen stehen hierbei exemplarisch für die ideale Nachsorge auch anderer immunsupprimierter Risikogruppen.

Abstract

One of the most significant challenges in transplantation medicine was and still is sufficient control of graft rejection. The drug-induced inhibition of cellular immune response, however, induces a significant increase of neoplasms, especially skin cancer. Invasive squamous cell carcinomas are the most frequently diagnosed malignomas in organ transplant recipients and due to the multifocal development and aggressive growth can represent a threat to immunocompromised patients. Interdisciplinary aftercare programs are based on epidemiological analyses of individual dermatological risk factors for skin cancer development, such as age, skin type, sun exposure, type and dosing of immunosuppression. Patient education programs, primary preventive measures (UV protection), individual risk-adapted immunosuppression protocols as well as proactive management even of early stages of skin cancer have been shown to be successful. Interdisciplinary surveillance concepts and treatment algorithms have been shown to serve as a model for all kinds of immunocompromised patients with an increased risk of skin cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Wisgerhof HC, Edelbroek JR, Fijter JW et al (2010) Trends of skin diseases in organ transplant recipients transplanted between 1966 and 2006: a cohort study with follow-up between 1994 and 2006. Br J Dermatol 1:390–396

    Article  Google Scholar 

  2. Hariharan S, Johnson CP, Bresnahan BA et al (2000) Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med 342:605–612

    Article  PubMed  CAS  Google Scholar 

  3. Traynora C, Jenkinson A, Williams Y (2012) Twenty-year survivors of kidney transplantation. Am J Transplant 12:3289–3295

    Article  Google Scholar 

  4. Kasiske BL, Snyder JJ, Gilbertson DT, Wang C (2004) Cancer after kidney transplantation in the United States. Am J Transplant 4:905–913

    Article  PubMed  Google Scholar 

  5. Euvrard S, Kanitakis J, Claudy A (2003) Skin cancer after organ transplantation. N Engl J Med 348:1681–1691

    Article  PubMed  Google Scholar 

  6. Bavinck JN, De Boer A, Vermeer BJ et al (1993) Sunlight, keratotic skin lesions and skin cancer in renal transplant recipients. Br J Dermatol 129:242–249

    Article  PubMed  CAS  Google Scholar 

  7. Carlson GW, Murray DR, Greenlee R et al (2000) Management of malignant melanoma of the head and neck using dynamic lymphoscintigraphy and gamma probe-guided sentinel lymph node biopsy. Arch Otolaryngol Head Neck Surg 126:433–437

    PubMed  CAS  Google Scholar 

  8. Lonsdorf AS, Becker MR, Stockfleth E et al (2010) Primary and secondary prevention of skin cancer in organ transplant recipients. Hautarzt 61:195–206

    Article  PubMed  CAS  Google Scholar 

  9. Bavinck JN, Tieben LM, Van der Woude FJ et al (1995) Prevention of skin cancer and reduction of keratotic skin lesions during acitretin therapy in renal transplant recipients: a double-blind, placebo-controlled study. J Clin Oncol 13:1933–1998

    PubMed  CAS  Google Scholar 

  10. Hardie IR, Strong RW, Hartley LC et al (1980) Skin cancer in Caucasian renal allograft recipients living in a subtropical climate. Surgery 87:177–183

    PubMed  CAS  Google Scholar 

  11. Lindelof B, Sigurgeirsson B, Gabel H, Stern RS (2000) Incidence of skin cancer in 5356 patients following organ transplantation. Br J Dermatol 143:513–519

    PubMed  CAS  Google Scholar 

  12. Penn I, First MR (1999) Merkel’s cell carcinoma in organ recipients: report of 41 cases. Transplantation 68:1717–1721

    Article  PubMed  CAS  Google Scholar 

  13. Hafner J, Kunzi W, Weinreich T (1999) Malignant fibrous histiocytoma and atypical fibroxanthoma in renal transplant recipients. Dermatology 198:29–32

    Article  PubMed  CAS  Google Scholar 

  14. Kripke ML (1994) Ultraviolet radiation and immunology: something new under the sun – presidential address. Cancer Res 54:6102–6105

    PubMed  CAS  Google Scholar 

  15. Ulrich C, Jürgensen JS, Degen A et al (2009) Prevention of non-melanoma skin cancer in organ transplant patients by regular use of a sunscreen: a 24 months, prospective, case-control study. Br J Dermatol 161 (Suppl 3):78–84

    Article  PubMed  Google Scholar 

  16. Dantal J, Hourmant M, Cantarovich D et al (1998) Effect of long-term immunosuppression in kidney-graft recipients on cancer incidence: randomised comparison of two cyclosporin regimens. Lancet 351:623–628

    Article  PubMed  CAS  Google Scholar 

  17. O’Donovan P, Perrett CM, Zhang X et al (2005) Azathioprine and UVA light generate mutagenic oxidative DNA damage. Science 309:1871–1874

    Article  Google Scholar 

  18. Jensen P, Hansen S, Møller B et al (1999) Skin cancer in kidney and heart transplant recipients and different long-term immunosuppressive therapy regimens. J Am Acad Dermatol 40:177–186

    Article  PubMed  CAS  Google Scholar 

  19. Euvrard S, Morelon E, Rostaing L et al (2012) Sirolimus and secondary skin-cancer prevention in kidney transplantation. N Engl J Med 367:329–339

    Article  PubMed  CAS  Google Scholar 

  20. Euvrard S, Ulrich C, Lefrancois N (2004) Immunosuppressants and skin cancer in transplant patients: focus on rapamycin. Dermatol Surg 30:628–633

    Article  PubMed  Google Scholar 

  21. Salgo R, Gossmann J, Schöfer H et al (2010) Switch to a sirolimus-based immunosuppression in long-term renal transplant recipients: reduced rate of (pre-)malignancies and nonmelanoma skin cancer in a prospective, randomized, assessor-blinded, controlled clinical trial. Am J Transplant 10:1385–1393

    Article  PubMed  CAS  Google Scholar 

  22. Halleck F, Budde K (2012) Transplantation: sirolimus for secondary SCC prevention in renal transplantation. Nat Rev Nephrol 8:687–689

    Article  PubMed  CAS  Google Scholar 

  23. Stasko T, Goldman GD (2001) Decreased skin cancer after cessation of therapy with transplant-associated immunosuppressants. Arch Dermatol 137:459–463

    PubMed  Google Scholar 

  24. Otley CC, Hirose R, Salasche SJ (2005) Skin cancer as a contraindication to organ transplantation. Am J Transplant 5:2079–2084

    Article  PubMed  Google Scholar 

  25. Rowe DE, Carroll RJ, Day CL Jr (1992) Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection. J Am Acad Dermatol 26:976–990

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist für sich auf folgende Beziehungen hin: CU hat Vortragshononare von den Firmen Pfizer, Novartis, Spirig, Galderma und Almirall erhalten.

Author information

Authors and Affiliations

  1. Klinik für Dermatologie, Venerologie und Allergologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    C. Ulrich & E. Stockfleth

  2. Medizinische Klinik mit Schwerpunkt Nephrologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland

    S. Brakemeier, K. Budde, H.H. Neumayer & P. Nickel

  3. Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité Universitätsmedizin Berlin, Berlin, Deutschland

    D. Dragun, J. Hörstrup, J.S. Jürgensen, A. Kahl, P. Reinke & R. Schindler

  4. Medizinische Klinik für Nephrologie, Transplantationsmedizin, Hypertensiologie und Internistische Intensivmedizin, Charité Universitätsmedizin Berlin, Berlin, Deutschland

    M. van der Giet

Authors
  1. C. Ulrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Brakemeier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Budde
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Dragun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Hörstrup
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J.S. Jürgensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Kahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. H.H. Neumayer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. P. Nickel
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. P. Reinke
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M. van der Giet
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. R. Schindler
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. E. Stockfleth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Ulrich.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ulrich, C., Brakemeier, S., Budde, K. et al. Hauttumoren nach Organtransplantation. Nephrologe 8, 239–246 (2013). https://doi.org/10.1007/s11560-012-0720-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11560-012-0720-1

Schlüsselwörter

Keywords

Search

Navigation