Posttransplant skin conditions vary widely by ethnicity

 

SAN DIEGO – A new study finds that the risk of skin cancers in organ transplant recipients may vary widely by ethnicity.

“The most important findings from our study are the high rates of keratinocyte neoplasms observed in our white Northern European patients, but also in those of Far East Asian descent. Dermatologists should also appreciate the high risk of Kaposi’s sarcoma (KS) in patients originating from Sub-Saharan Africa,” Jonathan Kentley, MBBS, of Royal London Hospital, said in an interview. He presented the study findings at the annual meeting of the American Academy of Dermatology.

“As the immune system plays a pivotal role in the surveillance and destruction of skin cancer, iatrogenic immunosuppression has a profound impact on morbidity and mortality in these patients,” he noted. “This presents a significant health issue for transplant recipients, and they are at an increased risk of almost every skin cancer. Squamous cell carcinoma (SCC), in particular, has been intensively studied, and some literature suggests that transplant recipients are at a more than 100-times increased risk of SCC.”

For the study, Dr. Kentley and colleagues sought to better understand ethnic differences in skin disorders in patients who have received organ transplants, since many previous studies have included few nonwhite subjects.

They analyzed an organ transplant center database for the years 1989-2016, and tracked 1,304 consecutive patients – which included 1,125 with skin problems. The overall population was 64% male with a median age in the early 40s, and almost all (1,276) had undergone renal transplants. A relative handful underwent liver, lung, heart, and pancreas transplants.

The majority of patients (885) were white Northern Europeans, but there were also significant numbers of people with South Asian (202), black African/Caribbean (131) and white/Mediterranean (52) heritage. A small number were Far East Asian (26) and Middle Eastern (8). The median follow-up time for the ethnic groups varied from about 5 years to about 12 years.

The researchers found that basal cell carcinoma was most common in white Northern European patients, at nearly 25%, with other groups under 10%. SCC was common in white Northern European patients and Far East Asians, both at nearly 25%.

 

By far, KS was the most common in black African/Caribbean patients, at nearly 11%. According to Dr. Kentley, researchers found the number of KS cases to be surprisingly high in this group, “compounded by the fact that we have had a number of additional cases in the past year after we had collected the data for this study.” He attributes the higher number of KS cases in these patients to an increased seroprevalence of its causative agent, human herpesvirus-8, in Sub-Saharan Africa. The rate of KS in the second most commonly affected group – white Mediterranean patients – was almost 2%.

Viral warts were common in most groups, with the rate in both white groups (white Northern European and white Mediterranean) at nearly 60%, and Far East Asians at about 65%. Porokeratosis was by far the most common in white Norther Europeans, at nearly 8%, and sebaceous hyperplasia was common in all groups (more than 20% to about 27%) except in the black African/Caribbean and South Asian groups.

All these results were statistically significant with P values less than .05.

“Our study has confirmed the increased risk of keratinocyte cancers in patients of white Northern European descent, as well as providing more information on the increased risk in patients of Far East Asian descent,” Dr. Kentley said. “We have also confirmed the propensity of black African/Caribbean patients to develop Kaposi’s sarcoma in the first 5 years post transplant and highlighted that white Mediterranean patients are also at high risk. Beyond this, we have been able to review the prevalence of rare malignancies, such as Merkel cell carcinoma and appendageal tumors, and highlight that white Northern European patients remain at high risk of developing these conditions.”

 

As for the impact on clinical practice, “the patterns of skin disease susceptibility we have identified have important implications for rational design of transplant skin surveillance programs, targeted patient (and provider) education, and optimized clinical management,” Dr. Kentley said. “Ultimately, this is likely to have a significant impact on strategic deployment of limited dermatology health care resources.”

Specifically, the study suggests that all organ transplant patients receive a baseline skin assessment visit and nurse-led targeted education. Black African/Caribbean patients should be followed up for at least 5 years after transplant.

In the United States, at least 724,000 people have undergone organ transplants since 1988, with most getting kidney transplants, according to the United Network for Organ Sharing (UNOS).

No study funding was reported. The authors had no disclosures.

SOURCE: Kentley J et al. AAD 2018, Session F055.

 

SAN DIEGO – A new study finds that the risk of skin cancers in organ transplant recipients may vary widely by ethnicity.

“The most important findings from our study are the high rates of keratinocyte neoplasms observed in our white Northern European patients, but also in those of Far East Asian descent. Dermatologists should also appreciate the high risk of Kaposi’s sarcoma (KS) in patients originating from Sub-Saharan Africa,” Jonathan Kentley, MBBS, of Royal London Hospital, said in an interview. He presented the study findings at the annual meeting of the American Academy of Dermatology.

“As the immune system plays a pivotal role in the surveillance and destruction of skin cancer, iatrogenic immunosuppression has a profound impact on morbidity and mortality in these patients,” he noted. “This presents a significant health issue for transplant recipients, and they are at an increased risk of almost every skin cancer. Squamous cell carcinoma (SCC), in particular, has been intensively studied, and some literature suggests that transplant recipients are at a more than 100-times increased risk of SCC.”

For the study, Dr. Kentley and colleagues sought to better understand ethnic differences in skin disorders in patients who have received organ transplants, since many previous studies have included few nonwhite subjects.

They analyzed an organ transplant center database for the years 1989-2016, and tracked 1,304 consecutive patients – which included 1,125 with skin problems. The overall population was 64% male with a median age in the early 40s, and almost all (1,276) had undergone renal transplants. A relative handful underwent liver, lung, heart, and pancreas transplants.

The majority of patients (885) were white Northern Europeans, but there were also significant numbers of people with South Asian (202), black African/Caribbean (131) and white/Mediterranean (52) heritage. A small number were Far East Asian (26) and Middle Eastern (8). The median follow-up time for the ethnic groups varied from about 5 years to about 12 years.

The researchers found that basal cell carcinoma was most common in white Northern European patients, at nearly 25%, with other groups under 10%. SCC was common in white Northern European patients and Far East Asians, both at nearly 25%.

 

By far, KS was the most common in black African/Caribbean patients, at nearly 11%. According to Dr. Kentley, researchers found the number of KS cases to be surprisingly high in this group, “compounded by the fact that we have had a number of additional cases in the past year after we had collected the data for this study.” He attributes the higher number of KS cases in these patients to an increased seroprevalence of its causative agent, human herpesvirus-8, in Sub-Saharan Africa. The rate of KS in the second most commonly affected group – white Mediterranean patients – was almost 2%.

Viral warts were common in most groups, with the rate in both white groups (white Northern European and white Mediterranean) at nearly 60%, and Far East Asians at about 65%. Porokeratosis was by far the most common in white Norther Europeans, at nearly 8%, and sebaceous hyperplasia was common in all groups (more than 20% to about 27%) except in the black African/Caribbean and South Asian groups.

All these results were statistically significant with P values less than .05.

“Our study has confirmed the increased risk of keratinocyte cancers in patients of white Northern European descent, as well as providing more information on the increased risk in patients of Far East Asian descent,” Dr. Kentley said. “We have also confirmed the propensity of black African/Caribbean patients to develop Kaposi’s sarcoma in the first 5 years post transplant and highlighted that white Mediterranean patients are also at high risk. Beyond this, we have been able to review the prevalence of rare malignancies, such as Merkel cell carcinoma and appendageal tumors, and highlight that white Northern European patients remain at high risk of developing these conditions.”

 

As for the impact on clinical practice, “the patterns of skin disease susceptibility we have identified have important implications for rational design of transplant skin surveillance programs, targeted patient (and provider) education, and optimized clinical management,” Dr. Kentley said. “Ultimately, this is likely to have a significant impact on strategic deployment of limited dermatology health care resources.”

Specifically, the study suggests that all organ transplant patients receive a baseline skin assessment visit and nurse-led targeted education. Black African/Caribbean patients should be followed up for at least 5 years after transplant.

In the United States, at least 724,000 people have undergone organ transplants since 1988, with most getting kidney transplants, according to the United Network for Organ Sharing (UNOS).

No study funding was reported. The authors had no disclosures.

SOURCE: Kentley J et al. AAD 2018, Session F055.

 

SAN DIEGO – A new study finds that the risk of skin cancers in organ transplant recipients may vary widely by ethnicity.

“The most important findings from our study are the high rates of keratinocyte neoplasms observed in our white Northern European patients, but also in those of Far East Asian descent. Dermatologists should also appreciate the high risk of Kaposi’s sarcoma (KS) in patients originating from Sub-Saharan Africa,” Jonathan Kentley, MBBS, of Royal London Hospital, said in an interview. He presented the study findings at the annual meeting of the American Academy of Dermatology.

“As the immune system plays a pivotal role in the surveillance and destruction of skin cancer, iatrogenic immunosuppression has a profound impact on morbidity and mortality in these patients,” he noted. “This presents a significant health issue for transplant recipients, and they are at an increased risk of almost every skin cancer. Squamous cell carcinoma (SCC), in particular, has been intensively studied, and some literature suggests that transplant recipients are at a more than 100-times increased risk of SCC.”

For the study, Dr. Kentley and colleagues sought to better understand ethnic differences in skin disorders in patients who have received organ transplants, since many previous studies have included few nonwhite subjects.

They analyzed an organ transplant center database for the years 1989-2016, and tracked 1,304 consecutive patients – which included 1,125 with skin problems. The overall population was 64% male with a median age in the early 40s, and almost all (1,276) had undergone renal transplants. A relative handful underwent liver, lung, heart, and pancreas transplants.

The majority of patients (885) were white Northern Europeans, but there were also significant numbers of people with South Asian (202), black African/Caribbean (131) and white/Mediterranean (52) heritage. A small number were Far East Asian (26) and Middle Eastern (8). The median follow-up time for the ethnic groups varied from about 5 years to about 12 years.

The researchers found that basal cell carcinoma was most common in white Northern European patients, at nearly 25%, with other groups under 10%. SCC was common in white Northern European patients and Far East Asians, both at nearly 25%.

 

By far, KS was the most common in black African/Caribbean patients, at nearly 11%. According to Dr. Kentley, researchers found the number of KS cases to be surprisingly high in this group, “compounded by the fact that we have had a number of additional cases in the past year after we had collected the data for this study.” He attributes the higher number of KS cases in these patients to an increased seroprevalence of its causative agent, human herpesvirus-8, in Sub-Saharan Africa. The rate of KS in the second most commonly affected group – white Mediterranean patients – was almost 2%.

Viral warts were common in most groups, with the rate in both white groups (white Northern European and white Mediterranean) at nearly 60%, and Far East Asians at about 65%. Porokeratosis was by far the most common in white Norther Europeans, at nearly 8%, and sebaceous hyperplasia was common in all groups (more than 20% to about 27%) except in the black African/Caribbean and South Asian groups.

All these results were statistically significant with P values less than .05.

“Our study has confirmed the increased risk of keratinocyte cancers in patients of white Northern European descent, as well as providing more information on the increased risk in patients of Far East Asian descent,” Dr. Kentley said. “We have also confirmed the propensity of black African/Caribbean patients to develop Kaposi’s sarcoma in the first 5 years post transplant and highlighted that white Mediterranean patients are also at high risk. Beyond this, we have been able to review the prevalence of rare malignancies, such as Merkel cell carcinoma and appendageal tumors, and highlight that white Northern European patients remain at high risk of developing these conditions.”

 

As for the impact on clinical practice, “the patterns of skin disease susceptibility we have identified have important implications for rational design of transplant skin surveillance programs, targeted patient (and provider) education, and optimized clinical management,” Dr. Kentley said. “Ultimately, this is likely to have a significant impact on strategic deployment of limited dermatology health care resources.”

Specifically, the study suggests that all organ transplant patients receive a baseline skin assessment visit and nurse-led targeted education. Black African/Caribbean patients should be followed up for at least 5 years after transplant.

In the United States, at least 724,000 people have undergone organ transplants since 1988, with most getting kidney transplants, according to the United Network for Organ Sharing (UNOS).

No study funding was reported. The authors had no disclosures.

SOURCE: Kentley J et al. AAD 2018, Session F055.