Skin cancer outcomes and risk factors in renal transplant recipients: Analysis of organ procurement and transplantation network data from 2000 to 2021

Abstract

PurposePosttransplant skin cancer is the most common malignancy after patients have undergone renal transplantation. Through comprehensive observation with a large sample size nationwide, understanding the risk factors and outcome of posttransplant skin cancer will help to develop appropriate patient surveillance and disease prevention strategies.Materials and methodsThis retrospective population-based cohort study was based on Organ Procurement and Transplantation Network data released in March 2021. Characteristics and outcomes, including patient survival and graft survival of recipients, were compared. Risk factors for posttransplant skin cancer, cancer onset momentum, and mortality were determined.ResultsA total of 199,564 renal transplant recipients were included. After renal transplantation, 7,334 (3.68%), 6,093 (3.05%), and 936 (0.47%) were diagnosed with squamous cell carcinoma, basal cell carcinoma, and melanoma, respectively. Skin cancer was the major cause of death (squamous cell carcinoma: 23.8%, basal cell carcinoma: 18%, and melanoma: 41.6%). Five-year survival rates ranked from best to worst were as follows: basal cell carcinoma (96.7 [95% confidence interval: 96.3–97.2]%), squamous cell carcinoma (94.1 [93.5–94.6]%), melanoma (89.7 [87.7–91.6]%), and cancer-free (87.4 [87.2–87.5]%) (p < 0.001 for all except melanoma vs. cancer-free, p = 0.534). Regarding graft survival, death-censored graft survival, posttransplant skin cancer, and melanoma were significantly better than the cancer-free group (p < 0.001). Independent risk factors for developing posttransplant skin cancer included older age, male sex, Caucasian race, pretransplant malignancy, polycystic kidney disease-induced end-stage renal disease (ESRD), retransplantation, private health insurance, T-cell depletion induction, and tacrolimus/mycophenolic acid use. Caucasian race and pretransplant malignancy were independent risk factors for posttransplant skin cancer onset momentum. Male sex, Caucasian race, pretransplant malignancy, hypertension- or diabetes-induced ESRD, retransplantation, diabetes history, deceased donor, cyclosporin, and mTOR inhibitor use were independent risk factors for posttransplant skin cancer mortality.ConclusionAlthough posttransplant skin cancer is a major cause of recipient death, information regarding its impact on patient and graft survival is limited. Given the differences regarding risk factors for posttransplant skin cancer incidence, onset momentum, and mortality, personalized approaches to screening may be appropriate to address the complex issues encountered by kidney transplant recipients.

Systematic Review of Calcineurin Inhibitors and Incidence of Skin Malignancies after Kidney Transplantation in Adult Patients: A Study of 309,551 Cases

“…This association has been reported before; however, in contrast to previous studies [19][20][21][22][23][24][25], we were able to demonstrate statistically significant differences in all three parameters of melanoma risk, non-melanoma skin cancer risk, and total skin cancer risk. Our results suggest that the increased risk of skin cancer associated with CNI treatment may not be as widespread an issue as previously thought.…”

“…The meta-analysis of outcomes presented by Alberu et al, Ascha et al, and Hao et al [ 19 , 20 , 23 ] prove a statistically significant association between the use of CNIs and an increased risk of melanoma (OR 1.09; 95% CI: 0.25–4.74; p < 0.01). The results are presented in Figure 2 .…”

“…The analysis of non-melanoma skin cancer risk based on five studies (Alberu et al, Hao et al, Krasova et al, Pinho et al, and Wisgerhof et al [ 19 , 21 , 23 , 24 , 25 ]) revealed a statistically significant difference with a lower risk of cancer development in the no CNIs group (OR 1.16; 95% CI: 0.41–3.26; p < 0.01). The data are shown in Figure 3 .…”

“…The analysis of non-melanoma skin cancer risk based on five studies (Alberu et al [19,22,23]). Patients who were taking CNIs had higher total skin cancer risk (OR 1.28; 95% CI: 0.10-16.28; p < 0.01).…”

Risk Factors and Innovations in Risk Assessment for Melanoma, Basal Cell Carcinoma, and Squamous Cell Carcinoma

“…Moreover, older age, male gender, Caucasian ethnicity, and the use of ciclosporin and tacrolimus therapies are associated with a substantially increased risk of melanoma in OTR [ 28 , 29 , 30 ]. The risk for melanoma more than doubles for individuals with non-Hodgkin’s lymphoma (RR: 2.4, 95% CI: 1.8–3.2) or with chronic lymphocytic leukemia (RR: 3.1, 95% CI: 2.1–4.4) [ 31 ].…”