Skin cancer in heart transplant recipients: Frequency and risk factor analysis

Background: The frequency of skin cancer is increased among organ transplan t recipients, but the predisposing risk factors are controversial. It is al so unclear whether heart transplant patients face an increased risk compare d to recipients of other organs, e.g. kidney transplants. Methods: We performed univariate and multivariate analysis of risk factors for skin cancer in 252 heart transplants and in a control series of 228 kid ney transplants followed up at a single center. An extensive dermatologic e xamination was carried out; baseline features, type of immunosuppression, n umber of 3A rejection episodes, extent of sunlight exposure and skin type w ere recorded. Multivariate analysis (Cox regression) included: age at trans plantation, sex, skin type (Fitzpatrick's criteria), presence of solar kera tosis, presence of warts, type of organ, sunlight exposure. Results: During follow up skin cancer was more common among heart transplan ts (40, 16%) than in kidney transplants (16, 7%, p = 0.004). The cumulative incidence of skin cancer by life table analysis increased from 16% after 5 years to 33% after 10 years in heart transplant patients and from 6% to 17 % in kidney transplants (p < 0.002). However, by multivariate analysis, age at transplant > 40 years (relative risk = 5.6), skin type II (relative ris k = 3) and sunlight exposure > 10000 hours (relative risk = 2.8), but not o rgan type were significant risk factors. Conclusion: Age at transplant, skin type and sunlight exposure, but not typ e of organ and type of immunosuppressive regimen, are associated with incre ased risk of skin cancer in heart transplantation.