Histopathological analysis of the skin of renal transplant recipients submitted to three different immunosuppression regimens

Abstract Background: Renal transplant recipients (RTRs) use a combination of immunosuppressive agents: a corticosteroid; a calcineurin inhibitor (cyclosporine or tacrolimus) and an antimetabolic agent (azathioprine [AZA] or a mycophenolic acid precursor [MPA] - Mycophenolate mofetil or sodium) or a...

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Main Authors: Maria Victória Quaresma, Luiz Sergio Azevedo, Elias David-Neto, Mírian Nacagami Sotto
Format: Article
Language:English
Published: Sociedade Brasileira de Dermatologia 2025-08-01
Series:Anais Brasileiros de Dermatologia
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Online Access:http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0365-05962025000300310&lng=en&tlng=en
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author Maria Victória Quaresma
Luiz Sergio Azevedo
Elias David-Neto
Mírian Nacagami Sotto
author_facet Maria Victória Quaresma
Luiz Sergio Azevedo
Elias David-Neto
Mírian Nacagami Sotto
author_sort Maria Victória Quaresma
collection DOAJ
description Abstract Background: Renal transplant recipients (RTRs) use a combination of immunosuppressive agents: a corticosteroid; a calcineurin inhibitor (cyclosporine or tacrolimus) and an antimetabolic agent (azathioprine [AZA] or a mycophenolic acid precursor [MPA] - Mycophenolate mofetil or sodium) or an mTOR inhibitor (mTORi) - sirolimus or everolimus. These treatments increase the incidence of various neoplasms, especially non-melanoma skin cancers (NMSCs). Objectives: To evaluate the histopathological alterations in the skin of the RTRs under three different immunosuppressive regimens: one mTORi (sirolimus or everolimus); or one antimetabolic agent (MPA or AZA), comparing them by groups and with healthy controls. Methods: This was a cross-sectional comparative study of 30 patients selected from the Renal Transplant Service and divided into three groups: mTORi (n = 10), MPA (n = 10), and AZA (n = 10). The control group consisted of 10 immunocompetent non-transplanted volunteers. All RTRs were using tacrolimus and prednisone. Each participant underwent two biopsies of intact skin: one in a sun-protected and another in a sun-exposed area. The specimens were analyzed without previous information on which group they belonged to. Results: The most significant histopathological change was thinning of the epidermis in the mTORi group, both in photoexposed and photoprotected skin. Study limitations: The study was conducted on a limited number of patients, which may influence the representativeness of the results. Conclusions: Only RTRs treated with mTORi presented interruption of epidermal proliferation. These findings help to understand the influence of these different types of immunosuppressive regimens and their subsequent potential effects on carcinogenesis.
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spelling doaj-art-7da744c34e1e4d648c016a5a26a6e8002025-08-20T03:44:10ZengSociedade Brasileira de DermatologiaAnais Brasileiros de Dermatologia0365-05962025-08-01100310.1016/j.abd.2024.07.016Histopathological analysis of the skin of renal transplant recipients submitted to three different immunosuppression regimensMaria Victória Quaresmahttps://orcid.org/0000-0003-2891-1650Luiz Sergio Azevedohttps://orcid.org/0000-0002-7117-5938Elias David-Netohttps://orcid.org/0000-0002-3310-0484Mírian Nacagami Sottohttps://orcid.org/0000-0001-6380-7192Abstract Background: Renal transplant recipients (RTRs) use a combination of immunosuppressive agents: a corticosteroid; a calcineurin inhibitor (cyclosporine or tacrolimus) and an antimetabolic agent (azathioprine [AZA] or a mycophenolic acid precursor [MPA] - Mycophenolate mofetil or sodium) or an mTOR inhibitor (mTORi) - sirolimus or everolimus. These treatments increase the incidence of various neoplasms, especially non-melanoma skin cancers (NMSCs). Objectives: To evaluate the histopathological alterations in the skin of the RTRs under three different immunosuppressive regimens: one mTORi (sirolimus or everolimus); or one antimetabolic agent (MPA or AZA), comparing them by groups and with healthy controls. Methods: This was a cross-sectional comparative study of 30 patients selected from the Renal Transplant Service and divided into three groups: mTORi (n = 10), MPA (n = 10), and AZA (n = 10). The control group consisted of 10 immunocompetent non-transplanted volunteers. All RTRs were using tacrolimus and prednisone. Each participant underwent two biopsies of intact skin: one in a sun-protected and another in a sun-exposed area. The specimens were analyzed without previous information on which group they belonged to. Results: The most significant histopathological change was thinning of the epidermis in the mTORi group, both in photoexposed and photoprotected skin. Study limitations: The study was conducted on a limited number of patients, which may influence the representativeness of the results. Conclusions: Only RTRs treated with mTORi presented interruption of epidermal proliferation. These findings help to understand the influence of these different types of immunosuppressive regimens and their subsequent potential effects on carcinogenesis.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0365-05962025000300310&lng=en&tlng=enHistopathologyImmunosuppression therapyKidney transplantationSkin neoplasms
spellingShingle Maria Victória Quaresma
Luiz Sergio Azevedo
Elias David-Neto
Mírian Nacagami Sotto
Histopathological analysis of the skin of renal transplant recipients submitted to three different immunosuppression regimens
Anais Brasileiros de Dermatologia
Histopathology
Immunosuppression therapy
Kidney transplantation
Skin neoplasms
title Histopathological analysis of the skin of renal transplant recipients submitted to three different immunosuppression regimens
title_full Histopathological analysis of the skin of renal transplant recipients submitted to three different immunosuppression regimens
title_fullStr Histopathological analysis of the skin of renal transplant recipients submitted to three different immunosuppression regimens
title_full_unstemmed Histopathological analysis of the skin of renal transplant recipients submitted to three different immunosuppression regimens
title_short Histopathological analysis of the skin of renal transplant recipients submitted to three different immunosuppression regimens
title_sort histopathological analysis of the skin of renal transplant recipients submitted to three different immunosuppression regimens
topic Histopathology
Immunosuppression therapy
Kidney transplantation
Skin neoplasms
url http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0365-05962025000300310&lng=en&tlng=en
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AT luizsergioazevedo histopathologicalanalysisoftheskinofrenaltransplantrecipientssubmittedtothreedifferentimmunosuppressionregimens
AT eliasdavidneto histopathologicalanalysisoftheskinofrenaltransplantrecipientssubmittedtothreedifferentimmunosuppressionregimens
AT miriannacagamisotto histopathologicalanalysisoftheskinofrenaltransplantrecipientssubmittedtothreedifferentimmunosuppressionregimens