Organ transplant recipients have a greater risk of keratinocyte cancers (KCs) due to immunosuppression, posing a significant clinical challenge. Although many studies have focused on the increased incidence of KC in solid organ transplant recipients (SOTR), the burden of disease directly relates to the number of skin cancers requiring therapy. This retrospective cohort study conducted in Brisbane, Australia, from 2017 to 2021 aimed to assess KC trends among kidney and lung transplant recipients and identify predictors and modifiable clinical practices to alleviate the burden of KCs.
Comprehensive data collected from patients attending dedicated skin cancer clinics included medical history, medications, and histopathology. Baseline questionnaires captured demographics, immunosuppressants, and sun exposure tendencies.
Among 240 enrolled patients (53% kidney transplant, 70% male, 64% over 45 years old, 36% with over 10 years of immunosuppression), 2384 KCs were excised over the study period. Prevalence ratio increased by 28% from 2017 to 2021 (p=0.005), with an average rise in KCs per patient from 2.3 to 2.9 (p=0.006). However, these changes in KC numbers were not homogenous across the population. Data analysis revealed heterogeneous trends: decreasing (11%), increasing (32%), stable-low (24%), stable high (11%), increase-then-decrease (7%), and no KCs (15%). Age, transplant type, chemoprophylaxis, and sun exposure significantly influenced KC trends.
Overall, SOTRs experience different trends in number of KCs over time. Understanding drivers of increase or decrease in numbers of KC will help manage this life-threatening complication through continuous surveillance and tailored interventions to address the escalating burden of KCs in this high-risk population.