Risk of infectious diseases and cutaneous tumours in solid organ recipients: A meta-analysis of literature

Table 1 Incidence of viral infections in solid organ recipients n (%)

Ref.	No. of cases/	Age (yr)	M/F	Median follow-	Therapy	HSV infections	VZV infections	HPV infections
	population			up time
Greenberg et al[53]	68/Kidney	NA	NA	NA	NA	10 (14.7)	NA	NA
Hogewoning et al[15]	134/Kidney	32.6 ± 10.3	80/54	NA	NA	9 (6.7)	24 (17.9)	NA
Bakr et al[11]	302/Kidney	35.9 ± 11.3	216/86	0.25-23 yr	Miscellaneous	9 (3)	3 (1)	33 (10.9)
Savoia et al[65]	286/Kidney	NA	273/163	9.3 (0.1-39.8) yr	66.7% combination therapy (tacrolimus in 90%)	11 (2.5)	NA	45 (10.3)
Belloni-Fortina et al[12]	161/Liver	47.4 ± 11	116/45	NA	NA	3 (2)	3 (2)	30 (19)
Lima et al[22]	53/Kidney	44	28/25	52.5% of patients over 5 yr	44% prednisone 31% mycophenolate	3 (5.7)	4 (7.5)	14 (26.4)

For each literature study has been indicated number of included patients, type of solid organ transplantation, median age, sex, median follow-up time after solid organ transplantation, type of immunosuppressive treatment and the percentage of patients affected by herpes simplex virus (HSV), varicella zoster virus (VZV) and human papilloma virus (HPV) infections. NA: Data non available in the considered study; M: Male; F: Female.

Table 2 Incidence of bacterial infections in solid organ recipients n (%)

Ref.	No. of cases/	Age (yr)	M/F	Median follow-	Therapy	Bacterial infections
	population			up time
Bakr et al[11]	302/Kidney	35.9 ± 11.3	216/86	0.25-23 yr	Miscellaneous	47 (16) Mainly folliculitis and impetigo
Hogewoning et al[15]	134/Kidney	32.6 ± 10.3	80/54	NA	NA	28 (20.9) Mainly folliculitis, ectyma and erysipelas (3)
Alangaden et al[66]	127/Liver	47 ± 12	79/62	NA	79% prednisone 72% tacrolimus 28% sirolimus	17 (13) Mainly wound infections and skin and soft tissue infections
Perera et al[21]	100/Liver	42.5	NA	5.5 (0.75-16) yr	35% cyclosporine, azathioprine and prednisone 48% prednisone and tacrolimus 17% tacrolimus	5 (5) Mainly folliculitis and 1 case of erythrasma
Sánchez-Lázaro et al[20]	604/Heart	51	506/98	First year after transplantation	NA	36 (5.9)
Savoia et al[65]	286/Kidney	NA	273/163	9.3 (0.1-39.8) yr	66.7% combination therapy comprising tacrolimus in 90%	6 (1.4) All cases of erysipelas
Lima et al[22]	53/Kidney	44	28/25	52.5% of patients over 5 yr	44% prednisone 31% mycophenolate	3 (5.7) 2 cases of furuncle and 1 cellulitis

For each literature study has been indicated number of included patients, type of solid organ transplantation, median age, sex, median follow-up time after solid organ transplantation, type of immunosuppressive treatment and the percentage of patients affected by bacterial infections; when available, type of bacterial infection has been specified. NA: Data non available in the considered study; M: Male; F: Female.

Table 3 Incidence of fungal infections in solid organ transplant recipients n (%)

Ref.	No. of cases/	Age (yr)	M/F	Median follow-	Therapy	Candida spp	Malassezia	Dermatophytes
	population			up time			furfur
Virgili et al[36]	73/Kidney	22-68	44/29	0.25-26 yr	50.7% association of prednisone, cyclosporine and azathioprine	4 (5.4)	20 (27.4)	7 (9.6)
Güleç et al[37]	102/Kidney	31.9 ± 10.3	68/34	4.5 ± 4.55 yr	38.2% association of prednisone, mycophenolate and cyclosporine	31 (30.4)	37 (36.3)	10 (9.8)
Perera et al[21]	100/Liver	42.5	NA	5.5 (0.75-16) yr	48% association of prednisone and tacrolimus	19%	4%	11%
Lima et al[22]	53/Kidney	44	28/25	NA	83% prednisone 58.5% mycophenolate 50.9% cyclosporine	14 (22.6)	9 (17)	8 (15)

For each literature study has been indicated number of included patients, type of solid organ transplantation, median age, sex, median follow-up time after solid organ transplantation, type of immunosuppressive treatment and the percentage of patients affected by fungal infections. NA: Data non available in the considered study; M: Male; F: Female.

Table 4 Incidence of fungal infections in solid organ transplant recipients n (%)

Ref.	No. of cases/	Age (yr)	M/F	Median follow-	Therapy	Sistemic	Candida spp	Aspergillus spp
	population			up time		infections
Collins et al[45]	158/Liver	46	84/74	NA	Cyclosporine, azathioprine and prednisone	34 (21.5)	28 (17.7)	5 (3.2)
Briegel et al[44]	141/Liver	47 ± 12	79/62	NA	Prednisone, cyclosporine and azathioprine	25 (17.7)	10 (7)	11 (7.8)
Kanj et al[46]	73/Heart-Lung	NA	NA	NA	NA	37 (50.6)	19 (26)	18 (24.6)
Abbott et al[47]	33479/Kidney	43	20154/13325	NA	72.2% with cyclosporine, 65.2% with mycophenolate	595 (1.7)	445 (1.3)	80 (0.2)
Singh et al[39]	130/Liver	NA	NA	NA	tacrolimus	11 (14)	6 (5)	4 (3)
Alangaden et al[66]	127/Kidney	47.1 ± 12.5	76/51	NA	72% tacrolimus	5 (3.9)	5 (3.9)	NA
Pugliese et al[67]	278/Miscellaneous	NA	NA	5.5 ± 5.9 yr	Various	46 (16.5)	45 (16.2)	1 (0.3)
Tessari et al[43]	3293/Miscellaneous	NA	2384/909	NA	NA	22 (0.7)	NA	NA

For each literature study has been indicated number of included patients, type of solid organ transplantation, median age, sex, median follow-up time after solid organ transplantation, type of immunosuppressive treatment and the percentage of patients affected by systemic fungal infections. NA: Data non available in the considered study; M: Male; F: Female.

Table 5 Risk to develop non-melanoma skin cancer and clinical characteristics of the various published series

Ref.	No. of cases/	NMSC	BCC/SCC	Median age at	Median follow-	Risk factors associated
	population		ratio	transplantation	up time	with NMSC
España et al[54]	92/Heart	15.2%	1:1.5	NA	NA	Immunosuppression
						UV exposure
						Skin type
Ong et al[68]	455/Heart	31%	3:1	NA	NA	Caucasian origin
	Australia					Age at transplantation
						Duration of follow up
Hiesse et al[5]	1710/Kidney France	7.5%-8.2%	NA	35.5 yr	9 yr	Cyclosporin
Moloney et al[8]	1755/Kidney	27.7%	1:2	40 yr	5.35 yr	Age at transplantation
	Irland					Duration of immunosuppression
						Age at transplantation
Mackenzie et al[49]	384/Kidney	25%	1:1.2	41.5 yr	5.3 yr (0.01-33.4)	Male sex
	New Zeland					Cyclosporine/Azathioprine
Sandoval et al[63]	91/Kidney Chile	16%	1:1-9	NA	7.3 yr (1 mo-29 yr)	Duration of immunosuppression
Fekecs et al[52]	116/Kidney, pancreas		1:4	49.3 yr	NA	Painful sunburns
	Hungary	9.5%				Occupational UV exposure
						Cyclosporine

For each literature study has been indicated number of included patients, type of solid organ transplantation, median age at transplantation, median follow-up time after solid organ transplantation, percentage of patients affected by NMSC and BCC/SCC ratio. Risk factors significantly associated to the development of non-melanoma skin cancer in each study are indicated in the right column. NA: Data non available in the considered study; UV: Ultraviolet; NMSC: Non-melanoma skin cancer; BCC: Basal cell carcinoma; SCC: Squamous cell carcinoma.