Skin cancer outcomes and risk factors in renal transplant recipients: Analysis of organ procurement and transplantation network data from 2000 to 2021

Xiaowei Hao; Wenhui Lai; Xinze Xia; Junnan Xu; Yangyang Wu; Chao Lv; Qingyang Meng; Kaikai Lv; Shuai Huang; Zhenjun Luo; Jun Dong; Qing Yuan

doi:10.3389/fonc.2022.1017498

Skin cancer outcomes and risk factors in renal transplant recipients: Analysis of organ procurement and transplantation network data from 2000 to 2021

Front Oncol. 2022 Nov 24:12:1017498. doi: 10.3389/fonc.2022.1017498. eCollection 2022.

Authors

Xiaowei Hao^{1

2}, Wenhui Lai^{1

3}, Xinze Xia^{1

4}, Junnan Xu¹, Yangyang Wu¹, Chao Lv¹, Qingyang Meng¹, Kaikai Lv¹, Shuai Huang^{1

3}, Zhenjun Luo^{1

5}, Jun Dong¹, Qing Yuan¹

Affiliations

¹ Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China.
² Department of Urology, No.971 Hospital of PLA Navy, Tsingtao, Shandong, China.
³ Department of Postgraduate, Hebei North University, Zhangjiakou, Hebei, China.
⁴ Department of Urology, Shanxi Medical University, Taiyuan, Shanxi, China.
⁵ Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China.

Abstract

Purpose: Posttransplant skin cancer is the most common malignancy after patients have undergone renal transplantation. Through comprehensive observation with a large sample size nationwide, understanding the risk factors and outcome of posttransplant skin cancer will help to develop appropriate patient surveillance and disease prevention strategies.

Materials and methods: This retrospective population-based cohort study was based on Organ Procurement and Transplantation Network data released in March 2021. Characteristics and outcomes, including patient survival and graft survival of recipients, were compared. Risk factors for posttransplant skin cancer, cancer onset momentum, and mortality were determined.

Results: A total of 199,564 renal transplant recipients were included. After renal transplantation, 7,334 (3.68%), 6,093 (3.05%), and 936 (0.47%) were diagnosed with squamous cell carcinoma, basal cell carcinoma, and melanoma, respectively. Skin cancer was the major cause of death (squamous cell carcinoma: 23.8%, basal cell carcinoma: 18%, and melanoma: 41.6%). Five-year survival rates ranked from best to worst were as follows: basal cell carcinoma (96.7 [95% confidence interval: 96.3-97.2]%), squamous cell carcinoma (94.1 [93.5-94.6]%), melanoma (89.7 [87.7-91.6]%), and cancer-free (87.4 [87.2-87.5]%) (p < 0.001 for all except melanoma vs. cancer-free, p = 0.534). Regarding graft survival, death-censored graft survival, posttransplant skin cancer, and melanoma were significantly better than the cancer-free group (p < 0.001). Independent risk factors for developing posttransplant skin cancer included older age, male sex, Caucasian race, pretransplant malignancy, polycystic kidney disease-induced end-stage renal disease (ESRD), retransplantation, private health insurance, T-cell depletion induction, and tacrolimus/mycophenolic acid use. Caucasian race and pretransplant malignancy were independent risk factors for posttransplant skin cancer onset momentum. Male sex, Caucasian race, pretransplant malignancy, hypertension- or diabetes-induced ESRD, retransplantation, diabetes history, deceased donor, cyclosporin, and mTOR inhibitor use were independent risk factors for posttransplant skin cancer mortality.

Conclusion: Although posttransplant skin cancer is a major cause of recipient death, information regarding its impact on patient and graft survival is limited. Given the differences regarding risk factors for posttransplant skin cancer incidence, onset momentum, and mortality, personalized approaches to screening may be appropriate to address the complex issues encountered by kidney transplant recipients.

Keywords: UNOS/OPTN; end stage renal disease (ESRD); renal transplantation (RT); risk factors; skin cancer.