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Organ transplant recipients are chronically immunosuppressed and their T-cell function is impaired. Ensuing diseases are mostly infections and are similar to those occurring in other conditions associated with T-cell impairment, such as AIDS. In addition, organ transplant recipients are at great risk for developing melanoma and nonmelanoma skin cancers. Bone marrow and stem cell graft recipients are at risk for graft-versus-host disease (GVHD).
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MOST COMMON INFECTIONS ASSOCIATED WITH ORGAN TRANSPLANTATION
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SKIN CANCERS ASSOCIATED WITH SOLID ORGAN TRANSPLANTATION
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Nonmelanoma skin cancer is the most common malignancy in adult solid organ transplant patients*.
The majority are squamous cell carcinomas (SCCs) (Section 11).
The risk of developing SCC increases exponentially with the length of immunosuppression.
The cumulative incidence is 80% after 20 years of immunosuppression in renal transplantation. SCCs in posttransplant patients are aggressive.
HPV infection is implicated in the pathogenesis.
Other epithelial proliferative lesions are actinic keratoses, keratoacanthomas, porokeratosis, appendage tumors, and Merkel cell carcinomas (Section 11).
Solid organ transplant recipients are at a higher risk for the development of melanoma (Section 12).
Lymphoproliferative disorders are common in graft recipients and related to Epstein–Barr virus-mediated proliferation of B cells.
Cutaneous T-cell lymphomas account for 30% of cutaneous lymphomas in transplant patients (Section 21).
Kaposi sarcoma occurs in immunosuppressed transplant recipients with an incidence of 0.5% to 5%. All cases are associated with Human herpesvirus 8 (HHV-8)infection (Section 21).
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GRAFT-VERSUS-HOST DISEASE (GVHD) ICD-10: T86.0
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GVHD is the totality of organ dysfunction caused by the action of histoincompatible, immunocompetent donor cells against the tissues of the host.
Graft-versus-host reaction (GVHR) is the expression of GVHD in a specific organ (e.g., cutaneous GVHR).
Acute cutaneous GVHD, usually occurs 10 to 100 days after bone marrow transplantation (BMT). However, diagnosis now rests of clinical features, not the number of days following transplantation. Liver and GI tract GVHR are also common in the acute setting.
Chronic cutaneous GVHD generally occurs >100 days after allogeneic BMT and manifests mostly as lichenoid and sclerodermoid changes but other morphologies may arise (anasarca, vitiliginous, keratosis-pilaris-like, bullous). Again, clinical features now define the diagnosis as opposed to days post-transplantation. Acute on chronic GVHD may occur.
Incidence. Allogeneic BMT: 20% to 80% of successful engraftments. Autologous BMT: Mild cutaneous GVHR occurs in less than 8%. Low incidence after repeated blood transfusion in immunosuppressed patients, maternal-fetal transfer in immunodeficiency disease.
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