Cutaneous viral infections in patients after kidney transplantation: risk factors

INTRODUCTION Infectious skin lesions are a common complication in renal transplant patients receiving immunosuppressive therapy. OBJECTIVES The aim of this study was to assess the prevalence and factors contributing to the development of viral skin infections in kidney transplant patients. PATIENTS AND METHODS The study included 486 patients, 296 men (60.9%) and 190 women (39.1%), aged 46.1 +/- 13.1 years, 74.3 +/- 52.1 months post-transplantation, who remained mostly on triple immunosuppressive therapy. All skin lesions detected during the dermatological examination were described in detail, and the type, size, exact location, dependence on age, sex, and the used immunosuppressive therapy were established. Patients were followed for 5 years. RESULTS Infectious skin lesions of viral origin were diagnosed in 189 of 486 patients (38.9%). The most frequent infections were viral warts (38.5%), which were more common in older patients (47.6 vs. 45.0 years, P < 0.033). Viral warts were observed more often in men (P < 0.031). Lesions of viral origin occurred more often in patients treated with immunosuppressive drugs for a longer period of time (53 vs. 37 months; P < 0.021) and those who received azathioprine and cyclosporine A (P < 0.001). In a multivariate logistic regression analysis, therapy with azathioprine was the only factor associated with increased risk of these complications (P < 0.007). CONCLUSIONS Older age, male sex, and longer duration of immunosuppressive therapy affect the incidence of infectious skin lesions in patients after kidney transplantation. Treatment with cyclosporine A and azathioprine promotes the development of infectious viral warts.