Title : Hidradenitis suppurativa in cardiac transplant recipients: Implications of immunosuppression on disease activity and clinical outcomes
Abstract:
Background: Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin disease affecting apocrine gland-bearing regions and characterized by painful nodules, abscesses, and sinus tract formation. Although traditionally considered a dermatologic condition, emerging evidence highlights its systemic inflammatory burden and association with cardiovascular comorbidities. In cardiac transplant recipients, lifelong immunosuppression may influence the natural course of HS—either attenuating disease activity or predisposing to complications such as superinfections and impaired wound healing. However, data specific to this population remain sparse.
Objective: To evaluate the interaction between immunosuppressive therapy and HS disease activity in cardiac transplant recipients, and to review its implications for post-transplant outcomes, infection risk, and therapeutic management.
Methods: We conducted a narrative review of peer-reviewed literature, including case series and reports describing HS in the setting of solid organ transplantation, with focused analysis on cardiac transplant recipients. Key variables assessed included HS severity pre- and post-transplant, infection complications, immunosuppressive regimen types and adjustments, and transplant-related outcomes. Immunomodulatory agents evaluated included calcineurin inhibitors, corticosteroids, antimetabolites (e.g., mycophenolate mofetil), mTOR inhibitors, and selected biologics.
Results: Findings suggest that chronic immunosuppression may stabilize or even improve HS activity in many transplant recipients. A recent case series of 26 patients with HS undergoing solid organ transplantation (including cardiac) demonstrated improvement or disease stability in >90% of cases post-transplant. Those with improvement were more likely to be on higher doses of prednisone and mycophenolate. Use of targeted biologics (e.g., adalimumab) in two patients alongside standard immunosuppressants resulted in HS control without adverse graft-related events. Nevertheless, the safety of combining TNF-α inhibitors or long-term antibiotics (e.g., clindamycin/rifampin) with standard immunosuppression remains insufficiently characterized. Additionally, HS is independently associated with increased cardiovascular risk, which may further complicate long-term transplant outcomes.
Conclusion: HS is an underrecognized comorbidity in cardiac transplant recipients that may be modulated by standard post-transplant immunosuppression. While many patients experience improvement, clinicians must remain vigilant for infectious complications and potential drug interactions. Collaborative care between dermatology and heart transplant teams is essential. Larger, prospective studies are needed to guide optimal management and immunomodulatory strategies in this complex patient population.
