器官移植受者(OTR)的鳞状细胞皮肤癌(SCSC)的风险显着升高,主要归因于用于预防移植物排斥的免疫抑制药物,尽管支持新药在SCSC风险中的作用的数据很少.我们在SCOT队列研究中调查了心脏和肾脏移植受者中免疫抑制药物与SCSC风险之间的关系。在皮肤活检自我报告后,通过病历审查确定事件病例(n=170)。没有SCSC的对照(n=324)与性别病例相匹配,年龄,种族,移植年,医院,供体类型,器官移植,以及移植和面谈之间的时间。使用条件逻辑回归来评估特定药物与SCSC之间的关联。使用抗代谢物硫唑嘌呤的患者发生SCSC的可能性是后者的两倍多(比值比[OR]=2.67,95%置信区间[CI]1.23-5.76)。相比之下,较新的抗代谢制剂(即,霉酚酸[MPA])与较低的SCSC风险相关(OR=0.45,95%CI0.29-0.69)。在没有硫唑嘌呤使用史的OTR中,MPA和SCSC之间的这种负相关仍然存在,即使同时使用钙调神经磷酸酶抑制剂他克莫司进行了调整(OR=0.52,95%CI0.32-0.84).我们的数据表明,与硫唑嘌呤相关的SCSC增加的风险在OTRs处方较新的方案中未见到。包括MPA和他克莫司。
Organ transplant recipients (OTRs) have a substantially elevated risk of squamous cell skin carcinoma (SCSC), largely attributed to immunosuppressive medications used to prevent graft rejection, although data to support the role of newer drugs in SCSC risk are sparse. We investigated the association between immunosuppressive medications and SCSC risk among cardiac and renal transplant recipients in the SCOT cohort study. Incident cases were ascertained through medical record review after self-report of skin biopsy (n = 170). Controls without SCSC (n = 324) were matched to cases on sex, age, race, transplant year, hospital, donor type, organ transplanted, and time between transplantation and interview. Conditional logistic regression was used to evaluate the association between specific medications and SCSC. Users of the antimetabolite azathioprine were more than twice as likely to develop SCSC (odds ratio [OR] = 2.67, 95% confidence interval [CI] 1.23-5.76). In contrast, the newer antimetabolite preparations (i.e., mycophenolic acid [MPA]) were associated with lower SCSC risk (OR = 0.45, 95% CI 0.29-0.69). This inverse association between MPA and SCSC persisted among OTRs with no history of azathioprine use, even after adjustment for simultaneous use of the calcineurin inhibitor tacrolimus (OR = 0.52, 95% CI 0.32-0.84). Our data suggest that the increased risk of SCSC historically associated with azathioprine is not seen in OTRs prescribed newer regimens, including MPA and tacrolimus.