organ transplants

Previous studies have found that organ transplants increase the risk of skin cancer. A recent study determines if the risk has decreased or remained the same.

Organ transplants are sometimes a necessary treatment for organ failures in the liver, kidney, lungs, and heart. Organ transplantation is a high-risk surgery.  One of the long-term risks is an increase in the risk of skin cancer.  Research so far has been inconclusive regarding the incidence of skin cancer after organ transplants, over time.  Although the risk remains high, health care practitioners need to know if the risk has been declining over time, or has remained the same.

Researchers in Sweden found no difference in the prognosis of patients after transplant operations since the 1980s to the present day. Dutch researchers have challenged this result, with recent studies showing a decline in the incidence of squamous cell carcinoma especially for patients who have undergone kidney transplantation.

To assess the prognosis of post-transplantation patients in Norway, Researchers Syed Rizwi and his colleagues at the Department of Nephrology of Oslo Hospital determined the rate of skin cancer after transplantation. They published their results in the 2017 edition of JAMA Dermatology.

The scientists used data from all patients who had received their first transplant from the year 1968 up to December 31, 2012. The study included all 8,026 kidney, heart, lung, and liver transplants performed in Norway during this time, excluding only those who died or moved away within 30 days, or who had a previous diagnosis of skin cancer. This prospective study followed patients for a mean of 6.7 years post surgery and noted the incidences of skin cancer, including squamous cell carcinoma, melanoma, and Kaposi sarcoma.

The results showed that the risk of squamous cell carcinoma declined drastically between the 1983-1987 period and the 2003-2007 period. In fact, after adjusting for all other variables, the incidences of squamous cell carcinoma declined to less than half in patients who underwent their transplants during 1998-2002, 2003-2007, and 2008-2012 periods. The incidences of skin cancer may have decreased so drastically due to the different immunosuppressant drugs used.  Cyclosporin, for example, was the most common immunosuppressant used during the 1983-1987 period, and its use has been largely phased out. Health care providers have focussed increasingly towards less aggressive, and more individualized treatments, which likely accounts for much of the improvements.

This study demonstrated that for the patients who had undergone organ transplants, the incidence of squamous cell carcinoma has significantly decreased since the mid-1980s. This reduction in the rate of post-transplant carcinoma may be explained by the advances in immune suppressive treatment and careful clinical follow-up.  In spite of these gains, the risk of squamous cell carcinoma in patients with organ transplants remains higher than in the general population and careful attention is required by patients, dermatologists, and transplant physicians.

Written by Dr. Apollina Sharma, MBBS, GradDip EXMD

Reference: Rizvi, Syed Mohammad Husain, et al. “Long-term Change in the Risk of Skin Cancer After Organ Transplantation: A Population-Based Nationwide Cohort Study.” JAMA dermatology (2017).

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