Lip actinic cheilitis and its relationship to clinical characteristics and immunosuppression in kidney transplant recipients
Aloizio P. Maciel1, Carlos A. Molina2, Daniela Ponce3, Elen A. Romão2, Paulo da Silva Santos1.
1Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry of University of São Paulo, Bauru, Brazil; 2Division of Infectious Diseases, Faculty of Medicine of Ribeirao Preto of University of São Paulo, Ribeirão Preto, Brazil; 3Department of Internal Medicine, Botucatu Medical School, University of São Paulo State–UNESP, Botucatu, Brazil
Commission of Dentistry of the Brazilian Association of Organ Transplantation (ABTO).
Introduction: Due to drug immunosuppression after kidney transplantation (KT), as well as factors such as chronic uremia and chronic sun exposure, Kidney Transplant Recipients (KTR) have a 46-fold increased incidence of Lip Cancer (LC). Because of the high prevalence of LC in KTR, there are concerns about its prevention, which can be accomplished by diagnosing Actinic Cheilitis (AQ) on lips, a potentially malignant oral lesion that can progress to LC.
Aim: The purpose of this investigation was to see if there was a link between the clinical manifestations of AQ and the clinical profile of KTRs.
Methods: Convenience sampling in a cross-sectional observational clinical study. An expert researcher completed the diagnosis and clinical staging of AQ in KTRs using Pointevin et al 2017 criteria and a clinical evaluation and photographic record of six different angulations of the lower lip were used to calibrate the researcher (Kappa intra-avaliador >0.8). Demographic data, time since KT, immunosuppressants, exposure to AQ risk factors such as alcoholism, smoking, chronic sun exposure, and exposure to volatile chemical agents, and history of positive serology for oncogenic viruses after KT were all obtained retrospectively from electronic medical records. For the association of variables, Chi-square and Macnemar tests were performed, with a significance value of (0.05).
Results: The sample size was 48 (100%) KTR, with 29 people diagnosed with AQ (60.41 percent). Light-siknned KTR was linked with the most severe AQ staging in 9 subjects (18.75 percent; p=0.035). History of exposure to volatile chemical agents (16.33 percent; p=0.007), drunkenness (15.25 percent; p=0.008), and smoking (20.66 percent; p=0.05) were also risk factors for AQ. A history of prolonged sun exposure was linked to a higher severity of QA 22(45.83 percent; p<0.001). The prevalence of AQ was linked to the usage of tacrolimus 43 (89,58 percent; p<0.001) and azathioprine 11 (22,91 percent; p0.001). However, the use of Mycophenolate Mofetil was linked to the most severe cases of AQ in 7 patients (14.58 percent; p=0.05). Individuals who got sirolimus, on the other hand, showed less AQ expression, with 7 patients (14.58 percent; P=0.016) manifesting with lesser degrees. After TxR, positive Epstein-Barr Virus serology was linked to the existence of AQ 17 (35,41 percent; p=0.028).
Conclusion: The presence and severity of AQ in KTR were linked to fair skin, chronic sun exposure, Epstein-Barr Virus infections, and the use of Mycophenolate Mofetil. Sirolimus appears to have a protective effect against the development of AQ. It is possible to select groups of patients at higher risk for AQ and, as a result, for LC using this clinical profile associated with the manifestation of AQ, allowing for prevention and early diagnosis.
This study was approved by the Ethics and Research in Human Beings Committee under protocol CAAE12798019.3.0000.5417.
