Subsequent non-melanoma skin cancers and impact of immunosuppression in liver transplant recipients

Publication date: Available online 4 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Pamela Funk-Debleds, Emilie Ducroux, Olivier Guillaud, José Ursic-Bedoya, Evelyne Decullier, Mélanie Vallin, Sylvie Euvrard, Georges-Philippe Pageaux, Olivier Boillot, Jérôme Dumortier
BackgroundNon-melanoma skin cancers (NMSC) are the most frequent cancers in solid organ transplant recipients, with a high rate of subsequent tumors.ObjectivesTo describe subsequent NMSC in a large cohort of liver transplant recipients (LTR) with long follow-up, and to analyze the factors influencing it, including immunosuppressive regimen.MethodsNinety-eight LTR (76 male) with a personal post-transplant history of squamous-cell carcinoma (SCC), basal-cell carcinoma (BCC) or Bowen's disease were included, with a median follow-up of 12.4 years (range: 1.5-27.8) after liver transplantation.ResultsMedian follow-up after first NMSC was 6.4 years (range: 0.17-22.1). Fifty-two (53.1%) patients developed 141 subsequent NMSC with a BCC/SCC ratio of 1.8:1. The actuarial risk of developing a second NMSC was 13.7% at 1 year, 28.4% at 2 years, 49.4% at 5 years, 65.7% at 10 years, and 88.4% at 15-years. Multivariate analysis found that phototype I-II (vs. III-IV) was a significant risk factor for second NMSC (HR: 2.556, 95%CI [1.45; 4.48], p=0.001), whereas withdrawal of calcineurin inhibitors (CNI) was significantly protective (HR: 0.358, 95%CI [0.142; 0.902], p=0.029).LimitationsRetrospective analysis.ConclusionsSubsequent NMSC are very frequent in LTR and conversion from CNI-based immunosuppressive regimen to mTORi/antimetabolite-based immunosuppressive regimen can reduce subsequent NMSC.