Patologia Dermatológica em Doentes Transplantados Hepáticos e Renais Referenciados à Consulta de Dermatologia e Venereologia

Abstract

Several skin disorders, immunosuppression-induced, have been described in transplant recipients. The aim of our study is to characterize the clinical spectrum of skin disorders and to compare the findings in liver and kidney transplant recipients. A retrospective descriptive study was conducted. Data were collected from the medical records of all liver and kidney transplant recipients from 2000 - 2010 who had been referred to our Dermato-Venereology Department. Three hundred nineteen transplant recipients (23.5%) have been seen, resulting in 410 diagnoses (230 in the subpopulation of liver transplant recipients and 180 in the subpopulation of kidney transplant recipients) grouped into 4 categories: 1) cutaneous infections; 2) skin cancer or premalignant skin lesions; 3) cutaneous side-effects; 4) non-iatrogenic skin disorders. Cutaneous infections were the most common presentations (42.2%), on average 32.7 months after transplantation. The latter group included 20.5% of fungal, 12.7% viral and 8.5% bacterial infections. Skin cancer and premalignant skin lesions made up 11.7% of all diagnoses, over a mean of 44.8 months post transplant and occurring primarily in kidney transplant recipients (20.6% vs 4.8% in liver transplantation patients; P < 0.001). The kidney transplant population had a squamous cell carcinoma (SCC) to basal cell carcinoma (BCC) ratio of 1.3:1 with SCC predominance, and the liver transplant population had a BCC:SCC ratio of 3.5:1. We also identified 10.5% of cutaneous side-effects and 35.6% of non-iatrogenic skin disorders. Although neoplastic pathology is more frequently mentioned in the literature, cutaneous infections were the most common diagnoses in our study. The significant differences between the two subpopulations studied may be related to higher immunosuppression after kidney transplantation. The high number of skin disorders reported in these patients makes it essential for Dermato-Venereology to be included within the multidisciplinary post-transplant care provided.