First and subsequent nonmelanoma skin cancers: incidence and predictors in a population of New Zealand renal transplant recipients.
BACKGROUND
Renal transplant recipients (RTRs) have an increased risk of developing nonmelanoma skin cancers (NMSCs). The aims of this study were to determine the incidence and subsequent history of NMSCs in RTRs, together with risk factors.


METHODS
All patients transplanted between July 1972 and March 2007, and followed up at Christchurch Hospital, New Zealand, were studied. Immunosuppression regimens were mostly prednisone, azathioprine, cyclosporine and prednisone, mycophenolate mofetil, cyclosporine since 1998.


RESULTS
Of 384 RTRs, 96 developed at least one NMSC. The median time to first NMSC was 18.3 years (95% CI 14.2, 22.9) from transplant, as estimated by survival analysis. Individual predictors of first NMSC in RTRs were older age at first transplant (P < 0.0001), male sex (P = 0.006) and initial immunosuppression regimen (P = 0.001); only age (P < 0.0001) and male gender (P = 0.003) were significant predictors in a joint model. The mean rate of subsequent NMSCs was 1.67 per year (95% CI = 1.32, 2.11). Older age at first renal transplant (P = 0.009) or at discovery of the first NMSC (P = 0.01) was associated with a higher annual rate of new NMSC following the discovery of the first NMSC. The median survival time to a second NMSC was 2.2 years (CI 1.4, 3.0). Fourteen patients died of metastatic squamous cell carcinoma (15% case fatality).


CONCLUSIONS
NMSCs are a major health issue for RTRs, especially in older males. Once RTRs have developed their first NMSC, ongoing surveillance and prompt treatment are essential.
Mackenzie
Katarzyna A
KA
Department of Pathology, University of Otago, Christchurch, New Zealand. kasia@mackenzies.co.nz
Wells
J Elisabeth
JE
Lynn
Kelvin L
KL
Simcock
Jeremy W
JW
Robinson
Bridget A
BA
Roake
Justin A
JA
Currie
Margaret J
MJ
D000328:Adult; D000367:Age Factors; D002280:Basal Cell Carcinoma / Q000453:epidemiology*; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012878:Skin Neoplasms / Q000453:epidemiology*
D007166:Immunosuppressive Agents