What you should know about your organ transplant patients

Solid organ transplantation is worth the wait for any patient facing organ failure. But it does come with unique risks and complications. People who have undergone solid organ transplantation are about 100 times more likely to develop skin cancer, according to Oscar Colegio, MD, PhD, a dermatologist at Roswell Park Comprehensive Cancer Center in Buffalo, New York.

Oscar Colegio, MD, PhD.

In this afternoon’s “Evidence-based Management of Transplant Recipients: Transplant Skin Cancer Network” (U016), Dr. Colegio will lead a panel discussion to discuss the latest research and potential treatments.

Why so many?

“The sheer number of skin cancers these patients develop is staggering,” said Dr. Colegio. “But so is the morbidity and the mortality that these patients face from skin disease that’s secondary to a medical procedure.”

One working belief as to why this is, said Dr. Colegio, is that patients have to take immunosuppression drugs after transplantation, which means they do not have a competent immune system.

“We’ve learned, especially in the last decade, that cancers can grow without being kept in check by the immune system,” he said.

Some of the drugs that patients take have direct effects on the skin cells that may lead to tumors or increased DNA damage within the skin.

“It’s really through loss of immunosurveillance and the direct effect of the drugs on the skin that likely leads to this staggering number compared to internal cancers, which are not increased at the same levels,” said Dr. Colegio, noting that lymphoma is an exception.

An individual’s risk for skin cancer is determined by how many skin cancers they’ve had in the past and how many precancers they currently have on their body.

Tailored approach needed

“By tailoring a screening regimen to the risk that somebody presents, we can actually achieve similar clinical outcomes for transplant patients versus high-risk, non-transplant patients,” Dr. Colegio said.

Another aspect of post-transplantation care, according to Dr. Colegio, is that patients often develop significant, benign skin conditions. However, they remain medically significant.

From lymphedema to cutaneous infections, Dr. Colegio recommends reviewing which conditions are more likely to be associated with specific drugs.

“The patients are usually on 20 different drugs, including three different immunosuppressants, so it can be confusing to determine which drug corresponds to which symptoms,” he said.

His goal is to remind clinicians to check for a particular drug when a specific symptom presents. For example, if the patient is presenting with unilateral leg swelling, you would know to check for a specific drug.

The session will help attendees recognize the causes of — and ultimately treat and manage —skin cancers, as well as other benign conditions for solid organ transplant recipients.