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Bartosz Foroncewicz, Krzysztof Mucha, Jan Lerut, Sławomir Majewski, Marek Krawczyk, Leszek Pączek
(Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland)
Ann Transplant 2014; 19:427-433
Psoriasis (PS) is one of the most frequent dermatologic diseases and occurs in approximately 2% of the population. It is believed to be an autoimmune disease (AID) that is potentially mediated by pro-inflammatory cytokines produced by lesional T cells. Infections are considered a key factor for triggering or even inducing PS flare-ups. Liver transplant recipients (LTR) with co-existing PS are unique to follow because their T cells are subject to long-term immunosuppression (IS) and they experience infections more frequently than the general population.
Material and Methods: Our 7.6±3.5-year follow-up aimed to determine the clinical course of PS in 10 patients out of 591 LTR (1.69%). Demographic data, IS protocols, signs of infections, and viral status were analyzed. The PS clinical course was assessed retrospectively by measuring the PS area and severity index.
Results: Remission was observed in all patients 2–6 weeks after liver transplantation (LT). Three patients had PS flare-ups within 2 years. Multivariant analysis did not reveal any correlations between recurrent PS (rPS) and cytomegalovirus (CMV), Epstein-Barr, human papilloma, hepatitis B and C viral status, or interferon treatment. rPS was only observed in LTR with co-existing AID. Response to therapy was variable, but cyclosporine (CsA) seemed to have a better effect than tacrolimus (TAC).
Conclusions: PS may relapse after LT despite IS, concomitant AID may be the main predisposing factor to disease relapses, and CsA seems to be more potent than TAC for treating rPS in LTR.
Keywords: Cyclosporine, Hepatitis, Autoimmune, Liver Cirrhosis, Biliary, Liver Transplantation, Psoriasis, Tacrolimus