Skin and Lip Cancer Risk Varies By Immunosuppression in Transplant Patients

MedicalResearch.com Interview with:

Claire M. Vajdic, PhD Center for Big Data Research in Health University of New South Wales Australian Graduate School of Management Bldg, Sydney Australia.

Dr. Claire Vajdic

Claire M. Vajdic, PhD
Center for Big Data Research in Health
University of New South Wales
Australian Graduate School of Management Bldg,
Sydney Australia on behalf of the authors.

Medical Research: What is the background for this study?

Dr. Vajdic: Lip cancer is one of the most common cancers in solid organ transplant recipients. Iatrogenic immunosuppression is a strong risk factor for lip cancer but the dose-related association between individual immunosuppressive agents and risk of lip cancer has not been examined. Therefore, we investigated the association between the type, dose and duration of immunosuppressive therapy and lip cancer risk in Australian liver, heart and lung transplant recipients.

Medical Research: What are the main findings?

Dr. Vajdic: With over two-decades of longitudinal immunosuppression data, we found that risk of lip cancer increased with high mean daily dose of azathioprine and longer duration of immunosuppression, as well as increasing year of age at transplantation, earlier transplant era and history of smoking. We provided the first epidemiological evidence in transplant recipients that higher doses of azathioprine are carcinogenic for lip cancer. Our findings also supported similar evidence and biological data for cutaneous squamous cell carcinoma

Medical Research: What should clinicians and patients take away from your report?

Dr. Vajdic: We suggest that solid organ transplant recipients treated with azathioprine should be frequently monitored for early changes in the appearance of their lip, particularly the external lip. We suggest that individuals at high-risk of squamous cell carcinoma of the lip or skin, such as those with fair skin and a history of sun exposure, should avoid using azathioprine where possible. Those transplant recipients who are not candidates for alternative immunosuppressive agents should avoid intense sun exposure, wear sun protective clothing and apply sun protection such as zinc-based creams.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Vajdic: We recommend future observational studies of transplant recipients ascertain and model longitudinal immunosuppression data in risk factor analyses. The inclusion of variables not available in our analysis, such as sun exposure and sun protection behaviours would also be valuable.

Medical Research: Is there anything else you would like to add?

Dr. Vajdic: As immunosuppressive agents have changed significantly over the past decade, large-scale studies that are able to include all present day immunosuppressive agents and individual data on sun exposure and sun protection behaviours is necessary to not only support our findings but also to provide further evidence of risk factors for lip cancer and the more common cutaneous squamous cell carcinoma in solid organ transplant recipients.

Citation:

High azathioprine dose and lip cancer risk in liver, heart, and lung transplant recipients: A population-based cohort study

Na, Renhua et al.

Journal of the American Academy of Dermatology , Volume 0 , Issue 0 ,

DOI: http://dx.doi.org/10.1016/j.jaad.2015.12.044

Claire M. Vajdic, PhD (2016). Skin and Lip Cancer Risk Varies By Immunosuppression in Transplant Patients 

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