Commentary
Dermatologic Manifestations in Kidney Transplant Recipients
Manifestaciones dermatológicas en los pacientes con trasplante renal
Á. Pulpillo Ruiz
Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen de Rocío, Sevilla, Spain
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"apellidos" => "Tomimori" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018303922" "doi" => "10.1016/j.ad.2018.07.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018303922?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018303792?idApp=UINPBA000044" "url" => "/15782190/0000010900000010/v1_201812060634/S1578219018303792/v1_201812060634/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Commentary</span>" "titulo" => "Dermatologic Manifestations in Kidney Transplant Recipients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "854" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Á. Pulpillo Ruiz" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Á." "apellidos" => "Pulpillo Ruiz" "email" => array:1 [ 0 => "aguedapulpillo@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen de Rocío, Sevilla, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manifestaciones dermatológicas en los pacientes con trasplante renal" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 2017, Spain once again became the leading country worldwide in organ and tissue donation and transplantation. In that year alone, Spanish hospitals performed 5261 transplants, up 9% from the previous year. Of these, 3269 were kidney transplants and 57 were in children. The success of our transplant model is such that 29 000 people in Spain are now living with a functioning kidney transplant. The maximum posttransplant survival time is 35 years (compared to 41 years for the world in general). That said, there are still some 27 000 patients with kidney failure who are still on dialysis.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The survival of transplanted organs depends on lifetime immunosuppressive medication, but this treatment increases the risk of infections and cancer.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> The switch from classic immunosuppressive agents to sirolimus in transplant recipients with a history of 1 or more nonmelanoma skin cancers has been associated with a reduced incidence of subsequent tumors because, in addition to its immunosuppressive properties, sirolimus also has antiproliferative and antiangiogenic effects.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Since the number of organ transplantations is increasing and recipients are living for longer, we are now seeing unusual dermatological manifestations that should be borne in mind when assessing these patients. The incidence of malignancies, such as angiosarcoma and posttransplant lymphoproliferative disorder, is growing.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4,5</span></a> Inflammatory diseases in this setting include inflammatory bowel disease,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> presenting with both specific (personal observation) and nonspecific manifestations.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> Other conditions include renal allograft rejection–associated bullous pemphigoid<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> and steal syndrome arising from the use of sirolimus, which, as mentioned, has antiangiogenic properties. Steal syndrome usually affects dialysis patients who have undergone arteriovenous fistula placement, but can also affect transplant recipients in whom this access is maintained. In such cases, it is advisable to check for signs of ischemia in the arm or leg with the fistula before administering the drug.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pulpillo Ruiz Á. Dermatologic Manifestations in Kidney Transplant Recipients. Actas Dermosifiliogr. 2018;109:854.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Memoria de actividad. ONT 2017." ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Epub ahead of print]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inpatient dermatology consultations in renal transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.R. Pereira" 1 => "A.M. Porro" 2 => "C.A. Seque" 3 => "V.P. Pasin" 4 => "J. 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