Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee.
Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA Dermatol. 2022 Nov 1;158(11):1287-1292. doi: 10.1001/jamadermatol.2022.3878.
Although it is known that patients with thoracic organ transplants develop skin cancer more frequently than those who receive nonthoracic organ transplants, patterns of risk for subsequent skin cancers are unknown.
To further characterize organ transplant recipients who develop multiple skin cancers and assess for patterns of development of additional skin cancers beyond the first skin cancer diagnosis by patient age and transplanted organ type.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used validated electronic health record-based data from a single tertiary care academic medical center to identify 5129 solid organ transplant recipients who underwent transplant surgery between 1992 and 2017 and were older than 18 years at the time of transplant. The cohort was limited to White patients because they have the highest skin cancer risk based on phenotype. The mean follow-up was 6.6 years. Data were analyzed June 9, 2021, to May 31, 2022.
Differences in rates of skin cancer development for first and subsequent skin cancers were measured using t test or analysis of variance and χ2 tests for continuous and categorical variables. Rates of skin cancer development were compared based on organ type and patient age at transplant using Fine-Gray tests and cumulative incidence plots.
A total of 5129 organ transplant recipients (mean [SD] age, 51.3 [12.9] years; 3287 men [64.1%]) were included. Of these, 695 patients (13.6%) had development of at least 1 skin cancer, with 6842 skin cancers identified in the cohort overall. Compared with liver transplant recipients, heart, lung, or kidney recipients were more likely to develop at least 1 skin cancer (χ2 test, 25.6; df, 4; P < .001). There was no significant difference by transplanted organ type in the rate of developing a second or third skin cancer; however, the age at transplant was associated with the time to developing a second (χ2 test, 20.4; df, 4; P < .001) or third (χ2 test, 10.9; df, 4; P < .02) skin cancer.
This cohort study found that there was no difference by organ type for development of subsequent skin cancers in organ transplant recipients, and recipients of all organ types developed additional skin cancers at high rates after the initial skin cancer.
尽管已知接受胸器官移植的患者比接受非胸器官移植的患者更频繁地患上皮肤癌，但随后皮肤癌的发病模式尚不清楚。
进一步描述发生多种皮肤癌的器官移植受者，并按患者年龄和移植器官类型评估首次皮肤癌诊断后额外皮肤癌的发展模式。
设计、地点和参与者：这项队列研究使用了单所三级保健学术医疗中心的经验证的基于电子健康记录的数据，确定了 5129 名在 1992 年至 2017 年间接受过移植手术且在移植时年龄大于 18 岁的实体器官移植受者。该队列仅限于白人患者，因为根据表型，他们的皮肤癌风险最高。平均随访 6.6 年。数据分析于 2021 年 6 月 9 日至 2022 年 5 月 31 日进行。
使用 t 检验或方差分析以及连续和分类变量的 χ2 检验来衡量首次和随后皮肤癌的癌症发生率差异。使用 Fine-Gray 检验和累积发病率图，根据器官类型和移植时患者年龄比较皮肤癌的发展率。
共纳入 5129 名器官移植受者（平均[SD]年龄 51.3[12.9]岁；3287 名男性[64.1%]）。其中，695 名患者（13.6%）至少发生了 1 种皮肤癌，该队列共发现 6842 种皮肤癌。与肝移植受者相比，心脏、肺或肾脏移植受者更有可能发生至少 1 种皮肤癌（χ2 检验，25.6；df，4；P < .001）。在发展第二或第三皮肤癌的发生率方面，不同移植器官类型之间没有显著差异；然而，移植时的年龄与发展第二（χ2 检验，20.4；df，4；P < .001）或第三（χ2 检验，10.9；df，4；P < .02）皮肤癌的时间有关。
这项队列研究发现，在器官移植受者中，不同器官类型的后续皮肤癌发病没有差异，所有器官类型的受者在首次皮肤癌后均以高比率发生额外的皮肤癌。
