טיפול פוטודינמי באור יום בקרטוזות אקטיניות על פני פנים וקרקפת: השוואת היעילות והבטיחות במושתלי איברים לעומת מטופלים אימונוקומפוטנטיים

Introduction

Photodynamic therapy (PDT) of nonmelanoma skin cancer (NMSC) and actinic keratoses (AK) among organ transplant recipients (OTR) is well established. However, reports regarding the efficacy and safety of day light activated (DL) PDT among OTR with NMSC/AK OTR are scarce.

Objectives

To summarize our experience with DL-PDT for the treatment of AK in OTR, and to compare its efficacy and safety in immunocompetent patients.

Patients & Methods

A retrospective analysis of a series of OTR with multiple AK located to their face and/or scalp, who underwent DL-PDT during 2017-2019. Outcomes were compared to immunocompetent patients with multiple AK who underwent DL-PDT at the same time period. Two dermatologists performed clinical evaluation independently using pre and post treatment standardized photographs. Improvement was evaluated using a quartile scale of lesions count reduction graded as 0 (exacerbation) to 4 (>75% reduction). Recurrence was defined as the presence of new AK requiring additional treatment.

Results

Twenty-four OTR (mean age 65+/- 11.6) and 75 immunocompetent patients (mean age 72.1+/-8.2) underwent DL-PDT. Average grade of improvement was 2.85 and 3.49 respectively (P=0.03). The number of required sessions to achieve maximal clearance was 3.5 and 1.25 respectively(P=0.007). Mean time till recurrence was 8.6 (+/- 4.1) and 17.65(+/- 6.4) months respectively(P=0.04).

Side effects were similar between the 2 groups.

Conclusions

OTR with AK may benefit from DL PDT, although the outcomes are inferior compared to immunocompetent patients. The results are consistent with previous literature regarding other field therapeutic modalities that proved to be less effective in OTR.