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Humane Papillomvirus-assoziierte Warzen bei organtransplantierten Patienten

Inzidenz, Risikofaktoren, Management

Human papillomavirus-associated warts in organ transplant recipients

Incidence, risk factors, management

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Zusammenfassung

Humane Papillomviren (HPV) zeigen für mehrschichtiges Plattenepithel der Haut einen ausgeprägten Epitheliotropismus. Neben der Induktion von Warzen werden HPV gelegentlich in Plattenepithelkarzinomen gefunden. Aufgrund einer inadäquaten Typ1-T-Zell-vermittelten Immunüberwachung bei organtransplantierten Patienten kommt es vermehrt zur Entwicklung von ausgedehnten und oftmals therapieresistenten Warzen. Hauttumoren, besonders Plattenepithelkarzinome, stellen die häufigste Neoplasie post transplantationem dar. Eine zeitliche sowie enge räumliche Assoziation zwischen dem Auftreten von Warzen sowie aktinischen Keratosen und invasiven Plattenepithelkarzinomen wurde beobachtet. In der Universitätsmedizin Berlin Charité wurden die prospektiv gesammelten Untersuchungsdaten von 1690 organtransplantierten Patienten ausgewertet. Primäres Ziel war die Evaluierung möglicher Risikofaktoren im Zusammenhang mit der Entstehung von Warzen. Sekundäres Ziel war die Überprüfung einer möglichen Korrelation zwischen dem Auftreten von Warzen und der Entwicklung epithelialer Hauttumoren. Die kumulative Inzidenz von Warzen steigt in den Jahren nach Transplantation stetig an. Eine Anzahl von mehr als 10 Warzen war mit der zeitversetzten Entwicklung aktinischer Keratosen, invasiver Plattenepithelkarzinome und Basalzellkarzinome assoziiert. Etablierte Risikofaktoren der kutanen Karzinogenese bei Organtransplantierten korrelieren ebenfalls mit dem Auftreten von Warzen. Im 2. Abschnitt des Beitrags wird das therapeutische Management von Warzen bei Organtransplantierten vorgestellt.

Abstract

Human papillomaviruses infect the squamous epithelia of the skin and cause warts, and are occasionally found in squamous cell carcinomas. Since cell-mediated immunity plays a crucial role in the control of HPV-infections, organ transplant recipients, unable to mount an adequate T-helper 1 cell-mediated immune surveillance, frequently develop widespread and resistant induced warts. Skin tumors, especially squamous cell carcinomas, are the most common post-transplantation neoplasm. Warts, actinic keratoses and invasive squamous cell carcinomas are known to develop at the same time in the areas. The role of HPV in the development of invasive squamous cell carcinoma under immunosuppression, remains to be elucidated in respect to common risk factors and increased numbers of warts potentially indentifing patients at increased risk for carcinoma. We prospectively studied 1690 organ transplant recipients in the dermatology clinic at the Charité University Hospital in Berlin, to evaluate risk factors being involved in the development of HPV-induced warts and to assess a potential association of with the development of non-melanoma skin cancers in this population. The cumulative incidence of warts steadily increased throughout the post-transplant years. The presence of more than 10 verrucae was associated with the development of actinic keratoses, invasive squamous cell carcinoma and basal cell carcinoma. This study shows clear evidence that certain risk factors of skin carcinogenesis in organ transplant recipient such as increased age at transplantation, a high dose of immunosuppression related to a specific type of graft and use of azathioprine or cyclosporine are strongly associated with an increased incidence of warts. Furthermore, HPV-induced verrucae vulgares could be used as a potential predictor for the development of coincidental non melanoma skin cancer in organ transplant recipients and therefore could serve as an early identification marker of skin cancer high-risk patients. The challenging management of warts in organ transplantation patients is reviewed.

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Authors and Affiliations

  1. Klinik für Dermatologie, Venerologie und Allergologie, Hauttumorcentrum Charité (HTCC), Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    D. Krüger-Corcoran, E. Stockfleth, A. Maltusch, W. Sterry, B. Lange-Asschenfeldt & C. Ulrich

  2. Klinik für Nephrologie, Campus Virchow Klinikum Charité, Universitätsmedizin Berlin, Berlin, Deutschland

    J.S. Jürgensen

  3. Deutsches Krebsforschungszentrum Heidelberg, Universität Heidelberg, Heidelberg, Deutschland

    I. Nindl

Authors
  1. D. Krüger-Corcoran
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  2. E. Stockfleth
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  3. J.S. Jürgensen
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  4. A. Maltusch
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  5. I. Nindl
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  6. W. Sterry
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  7. B. Lange-Asschenfeldt
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  8. C. Ulrich
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Correspondence to D. Krüger-Corcoran.

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Krüger-Corcoran, D., Stockfleth, E., Jürgensen, J. et al. Humane Papillomvirus-assoziierte Warzen bei organtransplantierten Patienten. Hautarzt 61, 220–229 (2010). https://doi.org/10.1007/s00105-009-1860-8

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