*Purpose: The purpose of this study is to identify the incidence of nonmelanoma skin cancer (NMSC) post lung transplantation and to examine the relationship between risk factors for NMSC and the time to development of NMSC post lung transplantation.

*Methods: A retrospective, single center study of lung transplant recipients transplanted between 2000 and 2019 was conducted to compare patients with a diagnosis of NMSC post transplantation (NMSC group) to those that did not develop NMSC post transplantation (control group). Patients were excluded if <18 years, had a previous lung transplant, or received a multi-organ transplant. Continuous and categorical variables were compared using T-tests and Chi-squared tests.

*Results: Of the 654 patients that met inclusion criteria (NMSC group=154), 614 were Caucasian, 332 were male, and the mean age at transplant was 57.7 ± 10.4 years. The most common indications for transplant were COPD/emphysema (n=302), IPF/UIP (n=254), and cystic fibrosis (n=47). The incidence of NMSC post lung transplant was 23.5% and the mean time to development of NMSC was 4.89 ± 3.71 years. Risk factors that correlated with development of NMSC included male gender (OR=1.61, p=0.011), Caucasian race (OR=13.8, p<0.001), rejection treatment with T-cell depleting agents (OR=2.08, p=0.001), and history of NMSC prior to transplant (OR=23.5, p<0.001). Cumulative days of exposure to maintenance immunosuppression and antifungal agents were also different between the NMSC and control groups for azathioprine (932 v. 290, p<0.001), mycophenolate (1625 v. 898, p<0.001), sirolimus (870 v. 272, p<0.001), tacrolimus (2429 v. 1296, p<0.001), and voriconazole (157 v. 88, p<0.001). Linear regression analyses were performed to assess the relationship between cumulative days of immunosuppression and the time to development of NMSC. Cumulative days of tacrolimus (569+0.002*[days], R²=0.674, p<0.001), azathioprine (1456+0.002*[days], R²=0.195, p<0.001), mycophenolate (1007+0.002*[days], R²=0.449, p<0.001), and sirolimus (1507+0.002*[days], R²=0.178, p<0.001) correlated with a faster onset of NMSC post transplantation.

*Conclusions: We identified strong predictors for the development of NMSC in lung transplant recipients, as well as the time to development of NMSC. A risk prediction model for the development of NMSC in lung transplant recipients is currently under development based on this large cohort of patients.

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