Accrual of non-melanoma skin cancer in renal-transplant recipients: experience of a Victorian tertiary referral institution.

Cutaneous carcinogenesis is increased in immunosuppressed organ transplant recipients (OTR). Tumour accrual is a useful measure for the rate of cutaneous carcinogenesis. There are few studies in tumour accrual rates in OTR in Australia. This was a prospective study of renal transplant recipients in a single tertiary referral centre over 5 years (60 months). Outcome measures included tumour accrual, and numbers of skin cancers according to clinical risk factors (age, sex, anatomical location, skin phototype, duration of immunosuppression, history of graft rejection, acitretin use, occupational sun exposure and family history of skin cancer). A total of 142 patients were included in the study, with a median follow-up duration of 1.9 years. Of these patients, 53 (37%) developed a total of 341 invasive non-melanoma skin cancers (NMSC) (253 squamous cell carcinoma [SCC] and 88 basal cell carcinoma [BCC]) over the study period. Accrual for SCC and BCC were 0.89 SCC/patient per year and 0.31 BCC/patient per year, respectively. The overall NMSC accrual was 1.20 NMSC/patient per year. SCC accrual increased with the duration of immunosuppression. NMSC accrual increased with a history of graft rejection. The current study provides prospective, histologically verified and quantitative evidence for the increase of cutaneous carcinogenesis in renal transplant recipients in Victoria, Australia.

Ng JC ，Cumming S ，Leung V ，Chong AH ... -  《-》

Risk factors for non-melanoma skin cancer in kidney transplant patients in a Spanish population in the Mediterranean region.

Bernat García J ，Morales Suárez-Varela M ，Vilata JJ ，Marquina A ，Pallardó L ，Crespo J ... -  《-》

[Patients with solid organ transplantation and skin cancer: determination of risk factors with emphasis in photoexposure and immunosuppressive regimen. Experience in a third level hospital].

Rodríguez-Acosta ED ，Calva-Mercado JJ ，Alberú-Gómez J ，Vilatoba-Chapa M ，Domínguez-Cherit J ... -  《Gaceta Medica de Mexico》

Incidence and prediction of nonmelanoma skin cancer post-renal transplantation: a prospective study in Queensland, Australia.

Nonmelanoma skin cancer (NMSC) is a significant clinical problem after renal transplantation, particularly in areas of high UV light exposure. A single-center prospective study of a population of Queensland renal transplant recipients was performed with the aims of: (1) establishing NMSC incidence and tumor accrual post-renal transplantation, and (2) developing a clinically derived predictive index to identify transplant recipients at greatest risk. Three hundred ten of 398 transplant recipients (78%) who underwent baseline assessment between July 1999 and April 2000 were reassessed a mean of 18 +/- 3.5 (SD) months later. A structured interview, full skin examination, biopsy of suspicious lesions, and review of medical and pathological records were used to determine the number and types of NMSC arising between the two assessments. Incidence (percentage of the population developing NMSC per year) and tumor accrual (number of tumors per person per year) were calculated. A clinically derived predictive index was generated using stepwise logistic regression models. Overall NMSC incidence was 28.1% and increased with duration of immunosuppression therapy: 18.8%, 24.8%, 33.3%, and 47.1% at less than 5, 5 to 10, 10 to 20, and greater than 20 years of immunosuppression therapy, respectively. Mean NMSC accrual was 1.85 +/- 3.84 tumors/person/y, increasing to 3.35 +/- 4.29 tumors/person/y after 20 years of immunosuppression therapy. Renal transplant recipients were stratified into categories of high and low NMSC risk by using predictive indices. Clinically derived predictive indices can allow NMSC risk stratification of an Australian transplant population and may provide an evidence-based and cost-effective approach to developing a targeted clinical NMSC surveillance program.

Carroll RP ，Ramsay HM ，Fryer AA ，Hawley CM ，Nicol DL ，Harden PN ... -  《-》

Comparison of skin cancers in liver and renal transplant recipients: Results of a prospective study in an Australian tertiary referral centre.

Organ transplant recipients (OTR) have an increased risk of skin cancers compared with the general population. A prospective study of renal (RTR) and liver transplant recipients (LTR) was conducted in a single New South Wales tertiary referral centre over 60 months. Initial and subsequent visit data were recorded in our transplant database. Only patients with a minimum of 11 months follow up were included. Altogether 142 RTR and 88 LTR were included in the analysis. Compared with RTR, the median age of liver transplant recipients was higher (64 vs 57 years), more men were patients (73 vs 60%) and there were higher rates of high-risk skin types (54 vs 33%) and heavy sun exposure (43 vs 30%). RTR developed 304 non-melanoma skin cancers (NMSC) with a squamous cell carcinoma:basal cell carcinoma ratio of 1.7:1. LTR developed 205 NMSC with a squamous cell carcinoma:basal cell carcinoma ratio of 1.6:1. The odds ratio of developing NMSC in LTR:RTR was 1.8:1 (95% CI: 1.02-3.11, P = 0.044) on univariate analysis but there was no difference on multivariate analysis. A previous history of NMSC, age, time from transplant from first visit, skin phenotype and previous sun exposure were significant risk factors for developing NMSC. Liver transplant recipients are not at a lower risk of NMSC than RTR. Our study supports routine and regular post-transplant skin surveillance of all LTR, like other OTR.

Ge L ，Chee SN ，Robledo KP ，Lowe P ... -  《-》