Subsequent nonmelanoma skin cancers and impact of immunosuppression in liver transplant recipients
Résumé
BACKGROUND: Nonmelanoma skin cancers (NMSCs) are the most frequent cancers in solid organ transplant recipients, with a high rate of subsequent tumors. OBJECTIVES: To describe subsequent NMSCs in a large cohort of liver transplant~recipients (LTRs) with long follow-up and analyze the factors influencing it, including immunosuppressive regimen. METHODS: A total of 96 LTRs (76 male) with a personal post-transplant history of squamous cell carcinoma, basal cell carcinoma or Bowen's disease were included, with a median follow-up of 12.4~years (range, 1.5-27.8) after liver transplantation. RESULTS: The median follow-up after first NMSC was 6.4~years (range, 0.17-22.1). In all, 52 patients (53.1%) developed 141 subsequent NMSCs with a basal cell carcinoma-to-squamous cell carcinoma ratio of 1.8:1. The actuarial risk for development of 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 skin phototype I or II (vs III or IV) was a significant risk factor for development of a second NMSC (hazard ratio, 2.556; 95% confidence interval, 1.45-4.48; P~=~.001), whereas withdrawal of calcineurin inhibitors was significantly protective (hazard ratio, 0.358; 95% confidence interval, 0.142-0.902; P~=~.029). LIMITATIONS: Retrospective analysis. CONCLUSIONS: Subsequent NMSCs are very frequent in LTRs, and conversion from a calcineurin inhibitor-based immunosuppressive regimen to a mammalian target of rapamycin inhibitor/antimetabolite-based immunosuppressive regimen can reduce subsequent NMSCs.
Mots clés
Statistics
Nonparametric
Skin Neoplasms
predictive factors
Squamous Cell
incidence
phenotype
Immunocompromised Host
Age Distribution
immunosuppression
Sex Distribution
skin cancer
Humans
Female
Male
Retrospective Studies
Adult
Aged
Follow-Up Studies
Kaplan-Meier Estimate
Middle Aged
Survival Analysis
Cohort Studies
Carcinoma
Basal Cell
Liver Transplantation
Predictive Value of Tests
Proportional Hazards Models
Risk Assessment
Immunosuppressive Agents