Organ transplant recipients who develop skin cancer face no difference based on type of organ transplanted for the development of subsequent skin cancers. Subsequent skin cancers developed at high rates following initial skin cancer among recipients of all organ types. These are among the study findings published in the Journal of the American Medical Association Dermatology.
Researchers aimed to characterize the development of skin cancers among organ transplant recipients, evaluating patterns of additional skin cancer development by transplanted organ type and patient age. The main outcomes were represented by the differences in rates of skin cancer development in first and subsequent skin cancers and a comparison based on transplant organ type and patient age for rates of skin cancer development.
Researchers conducted a single-center retrospective cohort study using electronic health record data at Vanderbilt University Medical Center, Nashville, Tennessee, a tertiary care academic medical center, to identify 5129 adult (>18 years of age) organ transplant recipients (mean 51.3±12.9 years of age) who underwent transplant surgery from 1992 through 2017. Only White patients (35.9% women) were included in this study as, according to researchers, based on phenotype, White patients have the greatest skin cancer risk. Additional inclusion criteria included patients with at least 25 billing codes in electronic records and those with data on immunosuppressants.
Researchers observed at least 1 skin cancer developed in 695 patients (13.6%) and overall, 6842 skin cancers were identified in this cohort. They found patients with skin cancer vs patients without skin cancer to be older (64.8 years vs 57.2 years), transplanted at an older age (53.7 vs 50.9), and have a longer follow-up after transplant (11.0 years vs 5.9 years) and all P <.001.
They noted at least 1 skin cancer was more likely to develop in lung (17.7%), kidney (16.5%), or heart (16.1%) recipients than in liver transplant (6.8%) recipients (χ2 test, 25.6; degrees of freedom [df], 4; P <.001). Among patients developing skin cancers the mean number of cancers per person was 9.8±15.1 and varied by transplant organ (kidney 11.9±17.6; heart 9.9±13.6; liver 5.2±6.5; lung 4.6±4.8 [P <.001]).
In the rate of developing a second or third skin cancer, researchers found no significant difference by transplanted organ type. They noted age at transplant was associated with time to developing a second skin cancer (χ2 test, 20.4; df, 4; P <.001) and a third skin cancer (χ2 test, 10.9; df, 4; P <.02).
Significant study limitations include using population and outcome definitions based on International Classification of Diseases and Current Procedural Terminology codes in the electronic health record instead of patient transplant registries, which may have led to a miscount of skin cancers, not including important variables (medications associated with differential skin cancer risks) in models, single-center design, retrospective design, and lack of generalizability.
They concluded that additional skin cancers developed at high rates following initial skin cancer among recipients of all organ types and “all patients had similar rates of development of subsequent skin cancers, whereas increasing age at transplant was associated with an increased risk of subsequent skin cancer.”
Wheless L, Anand N, Hanlon A, Chren MM. Differences in skin cancer rates by transplanted organ type and patient age after organ transplant in White patients. JAMA Dermatol. Published online September 28, 2022. doi:10.1001/jamadermatol.2022.3878