22 SKIN DISEASES IN ORGAN AND BONE MARROW TRANSPLANTATION

Skin Diseases in Organ and Bone Marrow Transplantation image








Most Common Infections Associated with Organ Transplantation* image


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Timeline of common infections after transplantation


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Figure 22-1. Timeline of common infections after transplantation.







Skin Cancers Associated with Organ Transplantation* image


image Nonmelanoma skin cancer is the most common malignancy in adult solid organ transplant patients.


image The majority are squamous cell carcinomas (SCC) (Section 11).


image The risk of developing SCC increases exponentially with the length of immunosuppression.


image The cumulative incidence is 80% after 20 years of immunosuppression in renal transplantation. SCC in posttransplant patients are aggressive.


image HPV infection is implicated in the pathogenesis.


image Other epithelial proliferative lesions are actinic keratoses, keratoacanthomas, porokeratosis, appendage tumors, and Merkel cell carcinomas (Section 11).


image Children with organ transplants may also be at higher risk for the development of melanoma (Section 12).


image Lymphoproliferative disorders are common in graft recipients and related to Epstein–Barr virus-mediated proliferation of B cells and most are lymphomas of B cell origin. Cutaneous T cell lymphomas account for 30% of cutaneous lymphomas in transplant patients (Section 21).


image Kaposi sarcoma occurs in immunosuppressed transplant recipients with an incidence of 0.5–5%. All cases are associated with Kaposi sarcoma-associated herpesvirus (KSHV) infection (Section 21).


*Clinical manifestations are discussed in their respective sections.











Graft-Versus-Host Disease ICD:9: 996.85 image ICD-10: T86.0 image


image GVHD is the totality of organ dysfunction caused by the action of histoincompatible, immunocompetent donor cells against the tissues of an immunocompetent host.


image Graft-versus-host reaction (GVHR) is the expression of GVHD in a specific organ (e.g., cutaneous GVHR).


image Acute cutaneous GVHR, usually occurring 10–30 days after bone marrow transplantation (BMT). It is the earliest and most frequent GVHR. Liver and GI tract GVHR are also common.


image Chronic cutaneous GVHR occurs >60 days after allogeneic BMT and manifests as lichenoid and sclerodermoid changes.


image Incidence. Allogeneic BMT: 20–80% of successful engraftments. Autologous BMT: mild cutaneous GVHR occurs in 8%. Low incidence after blood transfusion in immunosuppressed patients, maternal-fetal transfer in immunodeficiency disease.





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Dec 17, 2016 | Posted by in Dermatology | Comments Off on 22 SKIN DISEASES IN ORGAN AND BONE MARROW TRANSPLANTATION
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