Lee Wheless1,2,3, Nimay Anand4, Allison Hanlon1,3, Mary-Margaret Chren1. 1. Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee. 2. Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. 3. VA Tennessee Valley Healthcare System, Nashville. 4. Meharry Medical College, Nashville, Tennessee.
Abstract
Importance: Although it is known that patients with thoracic organ transplants develop skin cancer more frequently than those who receive nonthoracic organ transplants, patterns of risk for subsequent skin cancers are unknown. Objective: To further characterize organ transplant recipients who develop multiple skin cancers and assess for patterns of development of additional skin cancers beyond the first skin cancer diagnosis by patient age and transplanted organ type. Design, Setting, and Participants: This cohort study used validated electronic health record-based data from a single tertiary care academic medical center to identify 5129 solid organ transplant recipients who underwent transplant surgery between 1992 and 2017 and were older than 18 years at the time of transplant. The cohort was limited to White patients because they have the highest skin cancer risk based on phenotype. The mean follow-up was 6.6 years. Data were analyzed June 9, 2021, to May 31, 2022. Main Outcomes and Measures: Differences in rates of skin cancer development for first and subsequent skin cancers were measured using t test or analysis of variance and χ2 tests for continuous and categorical variables. Rates of skin cancer development were compared based on organ type and patient age at transplant using Fine-Gray tests and cumulative incidence plots. Results: A total of 5129 organ transplant recipients (mean [SD] age, 51.3 [12.9] years; 3287 men [64.1%]) were included. Of these, 695 patients (13.6%) had development of at least 1 skin cancer, with 6842 skin cancers identified in the cohort overall. Compared with liver transplant recipients, heart, lung, or kidney recipients were more likely to develop at least 1 skin cancer (χ2 test, 25.6; df, 4; P < .001). There was no significant difference by transplanted organ type in the rate of developing a second or third skin cancer; however, the age at transplant was associated with the time to developing a second (χ2 test, 20.4; df, 4; P < .001) or third (χ2 test, 10.9; df, 4; P < .02) skin cancer. Conclusions and Relevance: This cohort study found that there was no difference by organ type for development of subsequent skin cancers in organ transplant recipients, and recipients of all organ types developed additional skin cancers at high rates after the initial skin cancer.
Importance: Although it is known that patients with thoracic organ transplants develop skin cancer more frequently than those who receive nonthoracic organ transplants, patterns of risk for subsequent skin cancers are unknown. Objective: To further characterize organ transplant recipients who develop multiple skin cancers and assess for patterns of development of additional skin cancers beyond the first skin cancer diagnosis by patient age and transplanted organ type. Design, Setting, and Participants: This cohort study used validated electronic health record-based data from a single tertiary care academic medical center to identify 5129 solid organ transplant recipients who underwent transplant surgery between 1992 and 2017 and were older than 18 years at the time of transplant. The cohort was limited to White patients because they have the highest skin cancer risk based on phenotype. The mean follow-up was 6.6 years. Data were analyzed June 9, 2021, to May 31, 2022. Main Outcomes and Measures: Differences in rates of skin cancer development for first and subsequent skin cancers were measured using t test or analysis of variance and χ2 tests for continuous and categorical variables. Rates of skin cancer development were compared based on organ type and patient age at transplant using Fine-Gray tests and cumulative incidence plots. Results: A total of 5129 organ transplant recipients (mean [SD] age, 51.3 [12.9] years; 3287 men [64.1%]) were included. Of these, 695 patients (13.6%) had development of at least 1 skin cancer, with 6842 skin cancers identified in the cohort overall. Compared with liver transplant recipients, heart, lung, or kidney recipients were more likely to develop at least 1 skin cancer (χ2 test, 25.6; df, 4; P < .001). There was no significant difference by transplanted organ type in the rate of developing a second or third skin cancer; however, the age at transplant was associated with the time to developing a second (χ2 test, 20.4; df, 4; P < .001) or third (χ2 test, 10.9; df, 4; P < .02) skin cancer. Conclusions and Relevance: This cohort study found that there was no difference by organ type for development of subsequent skin cancers in organ transplant recipients, and recipients of all organ types developed additional skin cancers at high rates after the initial skin cancer.
Authors: M Way; L Marquart; D C Chambers; P Hopkins; K Miura; Z Jiyad; E I Plasmeijer; L E Ferguson; M Davis; D C Whiteman; H P Soyer; P O'Rourke; A C Green Journal: Br J Dermatol Date: 2020-02-23 Impact factor: 9.302
Authors: C A Harwood; D Mesher; J M McGregor; L Mitchell; M Leedham-Green; M Raftery; R Cerio; I M Leigh; P Sasieni; C M Proby Journal: Am J Transplant Date: 2012-10-16 Impact factor: 8.086
Authors: Giorgia L Garrett; Stefan E Lowenstein; Jonathan P Singer; Steven Y He; Sarah T Arron Journal: J Am Acad Dermatol Date: 2016-04-08 Impact factor: 11.527
Authors: Sylvie Euvrard; Emmanuel Morelon; Lionel Rostaing; Eric Goffin; Anabelle Brocard; Isabelle Tromme; Nilufer Broeders; Veronique del Marmol; Valérie Chatelet; Anne Dompmartin; Michèle Kessler; Andreas L Serra; Günther F L Hofbauer; Claire Pouteil-Noble; Josep M Campistol; Jean Kanitakis; Adeline S Roux; Evelyne Decullier; Jacques Dantal Journal: N Engl J Med Date: 2012-07-26 Impact factor: 91.245
Authors: Hyunje G Cho; Karen Y Kuo; Shufeng Li; Irene Bailey; Sumaira Aasi; Anne Lynn S Chang; Anthony E Oro; Jean Y Tang; Kavita Y Sarin Journal: JCI Insight Date: 2018-08-09