title: Risk of Aggressive Skin Cancers After Kidney Retransplantation in Patients With Previous Posttransplant Cutaneous Squamous Cell Carcinomas: A Retrospective Study of 53 Cases.
abstract: BACKGROUND
  The course of skin cancer after retransplantation in organ-transplant recipients who have already developed posttransplant skin cancer has not been assessed.
  
  
  METHODS
  This retrospective multicentric study included 53 patients with a history of cutaneous squamous cell carcinoma (SCC) after a first kidney transplantation who received a second kidney transplantation. The primary endpoint was the occurrence of aggressive cutaneous SCC after the second transplantation. Secondary endpoints included the course of skin cancers over 3 periods (first transplantation, return to dialysis, second transplantation), the time to occurrence, and risk factors for aggressive SCC after retransplantation.
  
  
  RESULTS
  The first SCC developed in 47 patients with a functional graft and in 6 after return to dialysis. After the first transplantation, 17 (33.3%) patients developed SCC in dialysis and 39 (73.6%) after the second transplantation, respectively. Twenty aggressive SCC developed over the study period. They occurred in 14 (26.4%) patients after retransplantation vs 5 (9.4%) after the first transplantation with a median delay of 50 months and were responsible for 5 deaths. Fair skin type, multiple tumors before retransplantation, treatment with azathioprine, T cell-depleting antibodies, and delayed revision of immunosuppression were associated with an increased risk of aggressive cutaneous SCC after retransplantation.
  
  
  CONCLUSIONS
  Candidates to retransplantation with a history of posttransplant SCC have a high risk of aggressive SCC. Our data suggest that the risk could be reduced by a tailored immunosuppression. A wait period may be required depending on the clinicopathological characteristics of the previous SCC and discussed on an individual patient basis.
authors.affiliation: 1 Department of Dermatology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France. 2 Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands. 3 Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France. 4 Université de Lyon, Laboratoire Santé Individu Société, Lyon, France. 5 Department of Dermatology, Nantes University Medical Center, Nantes, France. 6 Department of Dermatology, Saint Louis Hospital, APHP, University Paris VII, Paris, France. 7 Department of Dermatology, Tenon Hospital, APHP, University Paris VI, Paris, France. 8 Department of Transplantation and Nephrology, Edouard Herriot Hospital, Université de Lyon, Lyon, France. 9 Department of Nephrology-Transplantation, Necker Hospital, APHP, Paris, France. 10 Department of Dermatology, Charles-Nicolle University Medical Center, Rouen, France. 11 Department of Renal Medicine and Transplantation, Nantes University Medical Center, Nantes, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Ducroux
authors.forename: Clemmie
authors.initials: C
authors.lastname: Martin
authors.forename: Jan Nico
authors.initials: JN
authors.lastname: Bouwes Bavinck
authors.forename: Evelyne
authors.initials: E
authors.lastname: Decullier
authors.forename: Anabelle
authors.initials: A
authors.lastname: Brocard
authors.forename: Marlies E
authors.initials: ME
authors.lastname: Westhuis-van Elsäcker
authors.forename: Céleste
authors.initials: C
authors.lastname: Lebbé
authors.forename: Camille
authors.initials: C
authors.lastname: Francès
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Morelon
authors.forename: Christophe
authors.initials: C
authors.lastname: Legendre
authors.forename: Pascal
authors.initials: P
authors.lastname: Joly
authors.forename: Jean
authors.initials: J
authors.lastname: Kanitakis
authors.forename: Denis
authors.initials: D
authors.lastname: Jullien
authors.forename: Sylvie
authors.initials: S
authors.lastname: Euvrard
authors.forename: Jacques
authors.initials: J
authors.lastname: Dantal
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000139:chemically induced / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D005602:France; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012086:Reoperation / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012878:Skin Neoplasms / Q000139:chemically induced / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents