Skin cancer in kidney and heart transplant recipients and different long-term immunosuppressive therapy regimens

Background: Nonmelanoma skin cancer occurs frequently in organ transplant r ecipients, but the relative importance of different immunosuppressive thera py regimens is unclear. Objective: We studied the risk of skin cancer in the complete, single-cente r Norwegian cohort of kidney and heart transplant recipients (n = 2561). Methods: We determined cancer risk estimation by means of standardized inci dence ratios and multivariate Cox regression. Results: Transplant recipients had an increased risk of cutaneous squamous cell carcinoma (SCC) (65-fold), malignant melanoma (3-fold), and Kaposi's s arcoma (84-fold), and of lip SCC (20-fold), compared with the general popul ation. After adjustment for age, kidney transplant recipients receiving cyc losporine, azathioprine, and prednisolone had a significantly (2.8 times) h igher risk of cutaneous SCC relative to those receiving azathioprine and pr ednisolone. After adjustment for age and type of immunosuppressive regimen, heart transplant recipients had a significantly (2.9 times) higher risk th an kidney transplant recipients. Conclusion: The risk of cutaneous SCC, malignant melanoma, Kaposi's sarcoma , and lip SCC is increased in kidney and heart transplant recipients. The r isk of posttransplant cutaneous SCC is related to the degree of immunosuppr ession caused by long-term immunosuppressive therapy.