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Immunosuppressive treatment after solid organ transplantation and risk of post-transplant cutaneous squamous cell carcinoma

Ingvar, Asa LU orcid ; Smedby, Karin Ekström ; Lindelöf, Bernt ; Fernberg, Pia ; Bellocco, Rino ; Tufveson, Gunnar ; Höglund, Petter and Adami, Johanna (2010) In Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 25(8). p.71-2764
Abstract

BACKGROUND: The risk of cutaneous squamous cell carcinoma (CSCC) is found to be substantially increased after organ transplantation. The association with specific immunosuppressive regimens has been previously investigated, but results are not concordant. We aimed to clarify the relationship between separate immunosuppressive drugs, drug load, timing and risk of post-transplant CSCC.

METHODS: A population-based nested case-control study was performed in the Swedish organ transplantation cohort (n = 5931). All patients who developed CSCC during the follow-up (1970-97) were eligible as cases (n = 207). Controls (n = 189) were randomly selected from the cohort and individually matched to the cases on follow-up time, age at and... (More)

BACKGROUND: The risk of cutaneous squamous cell carcinoma (CSCC) is found to be substantially increased after organ transplantation. The association with specific immunosuppressive regimens has been previously investigated, but results are not concordant. We aimed to clarify the relationship between separate immunosuppressive drugs, drug load, timing and risk of post-transplant CSCC.

METHODS: A population-based nested case-control study was performed in the Swedish organ transplantation cohort (n = 5931). All patients who developed CSCC during the follow-up (1970-97) were eligible as cases (n = 207). Controls (n = 189) were randomly selected from the cohort and individually matched to the cases on follow-up time, age at and calendar period of transplantation. Exposure information was collected through extensive and standardized review of medical records.

RESULTS: The median time to CSCC was 6.7 years. Post-transplant azathioprine (Aza) treatment considerably increased the risk of CSCC during all time periods analysed, and the risk augmented with increasing dose and duration. Patients who after the entire follow-up period had received a high accumulated dose of Aza had an 8.8-fold increased risk of CSCC in multivariate analysis (P < 0.0001), compared to patients never treated with Aza. Additionally, a high accumulated dose of corticosteroids during the same period conferred a 3.9-fold elevated risk of CSCC (P = 0.09), compared to the lowest accumulated dose of corticosteroids. Cyclosporine treatment was not associated with the risk of CSCC post-transplantation.

CONCLUSIONS: This study provides evidence that Aza treatment, but not cyclosporine treatment, is strongly associated with post-transplant CSCC risk. The results suggest that the risk of CSCC after organ transplantation is not only an effect of the immunosuppressive load per se.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adolescent, Adult, Aged, Azathioprine/adverse effects, Carcinoma, Squamous Cell/chemically induced, Case-Control Studies, Child, Cohort Studies, Cyclosporine/adverse effects, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Graft Rejection/immunology, Heart Transplantation/immunology, Humans, Immunosuppressive Agents/adverse effects, Kidney Transplantation/immunology, Liver Transplantation/immunology, Lung Transplantation/immunology, Male, Middle Aged, Risk Factors, Skin Neoplasms/chemically induced, Sweden, Time Factors, Young Adult
in
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
volume
25
issue
8
pages
8 pages
publisher
Oxford University Press
external identifiers
  • scopus:77954765640
  • pmid:19729465
ISSN
1460-2385
DOI
10.1093/ndt/gfp425
language
English
LU publication?
no
id
07486169-f4dc-4ffd-9ac1-c7d0fcd2474d
date added to LUP
2020-11-16 09:42:46
date last changed
2024-05-29 03:28:59
@article{07486169-f4dc-4ffd-9ac1-c7d0fcd2474d,
  abstract     = {{<p>BACKGROUND: The risk of cutaneous squamous cell carcinoma (CSCC) is found to be substantially increased after organ transplantation. The association with specific immunosuppressive regimens has been previously investigated, but results are not concordant. We aimed to clarify the relationship between separate immunosuppressive drugs, drug load, timing and risk of post-transplant CSCC.</p><p>METHODS: A population-based nested case-control study was performed in the Swedish organ transplantation cohort (n = 5931). All patients who developed CSCC during the follow-up (1970-97) were eligible as cases (n = 207). Controls (n = 189) were randomly selected from the cohort and individually matched to the cases on follow-up time, age at and calendar period of transplantation. Exposure information was collected through extensive and standardized review of medical records.</p><p>RESULTS: The median time to CSCC was 6.7 years. Post-transplant azathioprine (Aza) treatment considerably increased the risk of CSCC during all time periods analysed, and the risk augmented with increasing dose and duration. Patients who after the entire follow-up period had received a high accumulated dose of Aza had an 8.8-fold increased risk of CSCC in multivariate analysis (P &lt; 0.0001), compared to patients never treated with Aza. Additionally, a high accumulated dose of corticosteroids during the same period conferred a 3.9-fold elevated risk of CSCC (P = 0.09), compared to the lowest accumulated dose of corticosteroids. Cyclosporine treatment was not associated with the risk of CSCC post-transplantation.</p><p>CONCLUSIONS: This study provides evidence that Aza treatment, but not cyclosporine treatment, is strongly associated with post-transplant CSCC risk. The results suggest that the risk of CSCC after organ transplantation is not only an effect of the immunosuppressive load per se.</p>}},
  author       = {{Ingvar, Asa and Smedby, Karin Ekström and Lindelöf, Bernt and Fernberg, Pia and Bellocco, Rino and Tufveson, Gunnar and Höglund, Petter and Adami, Johanna}},
  issn         = {{1460-2385}},
  keywords     = {{Adolescent; Adult; Aged; Azathioprine/adverse effects; Carcinoma, Squamous Cell/chemically induced; Case-Control Studies; Child; Cohort Studies; Cyclosporine/adverse effects; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Graft Rejection/immunology; Heart Transplantation/immunology; Humans; Immunosuppressive Agents/adverse effects; Kidney Transplantation/immunology; Liver Transplantation/immunology; Lung Transplantation/immunology; Male; Middle Aged; Risk Factors; Skin Neoplasms/chemically induced; Sweden; Time Factors; Young Adult}},
  language     = {{eng}},
  number       = {{8}},
  pages        = {{71--2764}},
  publisher    = {{Oxford University Press}},
  series       = {{Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association}},
  title        = {{Immunosuppressive treatment after solid organ transplantation and risk of post-transplant cutaneous squamous cell carcinoma}},
  url          = {{http://dx.doi.org/10.1093/ndt/gfp425}},
  doi          = {{10.1093/ndt/gfp425}},
  volume       = {{25}},
  year         = {{2010}},
}