Background. Organ transplant recipients are at high risk of post-transplant skin cancer (PTSC) which presents a clinical challenge to physicians. It has been reported that risk factors contributing to PTSC included skin cancer history, sun exposure and immunosuppressants. Here, we reinvestigated risk factors for PTSC after kidney transplant.
Materials and Methods. During 2000-2009, patients who received kidney graft were included in this study. Inclusion criteria were: (1) Adult recipients (age>20yrs); (2) followup>3 mo; (3) kidney transplant alone (KTA); and (4) primary graft. A total of 123,586 patients were selected using OPTN/UNOS data (Jul, 2012). In PTSC-free survival analysis, patients were followed until PTSC diagnosis, graft failure, or death. Significant factors in univariate analyses were included in multivariate Cox regression analysis.
Results. Incidences (per 1000 person-year) of PTSC for caucasian were 11.3, 1.49 hispanic, 0.93 asian/other races, and 0.34 African-American (A-A). After adjusting confounders, risks were the highest for caucasian (RR=28.4 vs A-A) and followed by hispanic (RR=4.49) and others (RR=2.66). Other significant risk factors were older age (RR=2.68 for age 50-59; 3.97 age 60-69; and 5.19 age 70+ vs age 20-49, respectively), male recipient (RR=1.65), living donor (RR=1.30), ALG/thymoglobulin (RR=1.44) or simulect (RR=1.16), Tacrolimus (RR=1.26) or azathioprine use (RR=1.31) during initial stay.
|Factors||Levels||Unadj RR (95% CI)||Adj RR (95% CI)|
|Recip Age||20-49 (ref)||1.0||1.0|
|50-59||2.80 (2.57-3.04)||2.68 (2.46-2.92)|
|60-69||4.29 (3.94-4.69)||3.97 (3.64-4.32)|
|70+||6.37 (5.70-7.12)||5.19 (4.64-5.81)|
|Male Recip||vs Female||1.74 (1.63-1.86)||1.65 (1.54-1.76)|
|Recip Ethnicity||Caucasian||33.2 (24.0-44.1)||28.4 (21.3-37.7)|
|Hispanic||4.40 (3.15-6.14)||4.49 (3.14-6.13)|
|Asian/Others||2.74 (1.81-6.16)||2.66 (1.75-4.03)|
|Living Donor||vs Deceased||1.42 (1.36-1.51)||1.30 (1.22-1.38)|
|ALG/Thymo||1.46 (1.36-1.56)||1.44 (1.34-1.54)|
|Simulect||1.26 (1.16-1.36)||1.16 (1.07-1.25)|
|Tacrolimus @DC||Yes vs others||1.17 (1.10-1.25)||1.26 (1.18-1.35)|
|Azathiioprine @DC||Yes vs others||1.50 (1.24-1.82)||1.31 (1.08-1.58)*|
Conclusions: Caucasians are at a 28-fold increased risk for PTSC compared with African-American. Early detection and timely treatment of skin cancer for high risk patients is recommended.
To cite this abstract in AMA style:Cho Y, Hutchinson I, Shah T. High Incidence of De Novo Post-Transplant Skin Cancer among Caucasian Recipients after Kidney Transplantation – An Analysis of OPTN/UNOS Data [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/high-incidence-of-de-novo-post-transplant-skin-cancer-among-caucasian-recipients-after-kidney-transplantation-an-analysis-of-optnunos-data/. Accessed January 16, 2018.
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