Caring for Transplant Patients

For Medical Professionals

  • Organ Transplant Recipients are at high risk for developing skin cancer.
  • Transplant patient's risk for skin cancer increases each year following transplantation.
  • Skin cancer in transplant patients can be life threatening and affect quality of life. 

General information about Organ Transplantation

>140,000 persons living in the US have solid-organ transplants
> 25,000 transplants are performed in the US annually

Organ Transplanted Number
Total 25,458
Kidney 15,129
Liver 5671
Pancreas 502
Kidney/Pancreas 871
Heart  2055
Lung 1085
Heart/lung 29
Intestine

116

High Incidence of Skin Cancer in Organ Transplant Patients

  • Most common malignancy in the setting of solid-organ transplantation and immunosuppression
  • Incidence of skin cancer is substantially increased with extended survival after organ transplant
  • NMSC accounts for 90% of all skin cancers in transplant patients
  • NMSC rate > 100x that of the general populations (1)
Skin Cancer Increase in Incidence
SCC   65-fold
SCC of lip   20-fold
BCC   10-fold
Melanoma   3.4-fold
Kaposi’s sarcoma   84-fold

Incidence of other NMSC are also increased

  • Merkel cell carcinoma
  • Eccrine carcinoma
  • Atypical fibroxanthoma (AFX)
  • Malignant fibrous histiocytoma (MFH)
  • Angiosarcoma
  • Cutaneous lymphoma

Muitiple Skin Cancers can occur simultaneously

  • Once a transplant patient develops a single NMSC
    • 25% will develop another NMSC within 13 months
    • 50% will develop additional skin cancer within 3.5yrs
  • As many as 12% of transplant patients may develop > 5 NMSC/year (3)

Risk Factors

O'Reilly et al (4) Carucci et al (5)
Increased age

Older age at transplant
Male sex
Increased exposure to UV radiation
 

Sun exposure
Duration and intensity of immunosuppression

Intense immunosuppression
Fitzpatrick skin types I, II or III

Fair skin
Personal history of Actinic Keratoses, NMSC or melanoma, Kaposi's sarcoma, cutaneous lymphoma
 

History of Actinic Keratoses or skin cancer
Heart recipients > kidney recipients > liver recipients

 

Heart recipients
HPV infection

HPV 5 and 8
CD4 lymphocytopenia