Organ transplant recipients are up to 200 times more likely to develop cutaneous squamous cell carcinoma (SCC) than age-matched general populations. Systemic retinoids, such as acitretin, may prevent the development of SCC. However, their use has been associated with adverse side effects and should be used with caution in patients with renal impairment (RI). We aimed to determine the safety and effectiveness of acitretin as a suitable chemopreventative agent against the development of SCC in long-term renal transplant recipients (LRTR).

We collected retrospective data from a large cohort (n=469) of LRTR (>7 years), of which n=108 had been diagnosed with non-melanoma skin cancer. We identified patients (n=12) on treatment with acitretin for the prevention of SCC. We matched these to an equal number of controls by age, total years from transplant and Fitzpatrick skin type. We compared GFR, liver function (LFTs) and lipid profile at 1 year pre, and 1, 3 and 5 years post commencing acitretin. We also compared the total number of SCCs pre and post acitretin. Wilcoxon signed-rank test was used to compare blood chemistry values before and after acitretin treatment within cases, and a Mann-Whitney test was used to compare differences between cases and controls.

Serum total cholesterol concentrations and LDL were significantly lower (p=0.007 and p=0.012 respectively) in patients prescribed acitretin at 5 years post treatment compared with baseline measurements. There were no other statistically significant differences in lipid profile, GFR or LFTs at baseline parameters and at 1, 3 and 5 years after starting treatment within cases or comparing cases and controls. During the 5 years after starting acitretin treatment the median number of new SCCs per patient was 2 (range 0-4), significantly lower than the median number prior to treatment of 6 (range 3-10) p=0.005.

Acitretin treatment did not adversely affect lipid profiles, liver or renal function when compared with baseline or matched untreated control data, and was associated with a statistically significant reduction in total number of new SCCs during 5-year follow-up. Acitretin should be considered as a safe and effective chemoprevention agent in carefully selected LRTR with multiple SCCs who are under regular dermatology surveillance. Further research to assess whether its use may circumvent the need to reduce or withdraw immunosuppression treatment in LRTR with SCCs is warranted.

CITATION INFORMATION: Anand R, Hung R, Frame S, Bramham K, Wain M, Cronin A. Chemoprevention of Cutaneous Squamous Cell Carcinoma in Renal Transplant Recipients: A Case-Controlled Analysis. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress