title: The incidence and risk factors of de novo skin cancer in the liver transplant recipients.
abstract: BACKGROUND
  Liver transplantation (LT) increases the risk of de novo malignancies including skin cancers. However, risk factors for this type of cancers have not been well studied.
  
  
  OBJECTIVE
  To determine the incidence of skin cancer in LT recipients, and to identify the risk factors of this type of cancer.
  
  
  METHODS
  We identified all adult patients who underwent LT and developed de novo skin cancer post-LT at our institution between 1996 and 2009. We excluded the patients with history of skin cancer prior to LT. We also studied a control group of patients who underwent LT during the same period but did not develop skin cancer; the control group was matched (1:2) for age, gender and geographical place of residence.
  
  
  RESULTS
  Over a median (IQR) follow-up of 41.5 (18.0, 98.6) months, 23 (2.3%) of 998 patients developed skin cancer post-LT, of whom 10 were identified with squamous cell carcinoma, 9 with basal cell carcinoma and 4 with melanoma. After adjusting the confounding variables, subjects who had combined liver/kidney transplant had 22 (95% CI: 5.1-99) times higher hazard of skin cancer compared to subjects with LT alone. Furthermore, patients who had non-skin cancer prior to LT had 23 (95% CI: 8.6-60) times higher hazard developing skin cancer after the transplant. Patients with history of alcohol consumption, as the underlying etiology of liver disease, had 4 (95% CI: 1.2-12.9) times higher hazard of developing skin cancer after transplantation. Type or duration of immunosuppression was not associated with increased risk of skin cancer post-LT. The post-LT survival outcome was not affected by the development of de novo skin cancer post-LT.
  
  
  CONCLUSIONS
  Skin cancer is relatively common in LT recipients and should be monitored, particularly in patients with a history of pretransplant malignancy, recipients of combined liver and kidney transplant or having alcoholic cirrhosis as the underlying cause of liver disease.
authors.affiliation: Department of Internal Medicine.
authors.forename: J
authors.initials: J
authors.lastname: Modaresi Esfeh
authors.affiliation: Department of Gastroenterology and Hepatology.
authors.forename: I A
authors.initials: IA
authors.lastname: Hanouneh
authors.affiliation: Department of Quantitative Health Sciences.
authors.forename: D
authors.initials: D
authors.lastname: Dalal
authors.affiliation: Department of Gastroenterology and Hepatology.
authors.forename: A
authors.initials: A
authors.lastname: Tabba
authors.affiliation: Department of Quantitative Health Sciences.
authors.forename: R
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Department of Gastroenterology and Hepatology.
authors.forename: M
authors.initials: M
authors.lastname: Pagadala
authors.affiliation: Department of General Surgery, Transplant Center, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: B
authors.initials: B
authors.lastname: Eghtesad
authors.affiliation: Department of Gastroenterology and Hepatology.
authors.forename: N N
authors.initials: NN
authors.lastname: Zein
keywords: Liver transplantation; de novo malignancy; skin cancer