Non-melanoma skin cancer and its risk factors in an Austrian population of heart transplant recipients receiving induction therapy

Alexandra Geusau, Daniela Dunkler, Eva Messeritsch, Nicolaus Sandor, Gudrun Heidler, Suzanne Rödler, Jan Ankersmit, Andreas Zuckermann, Erwin Tschachler
International Journal of Dermatology 2008, 47 (9): 918-25

BACKGROUND: Solid organ transplant recipients have a high risk of developing nonmelanoma skin cancers (NMSC). We describe the characteristics and incidence of skin tumors in an Austrian population of heart transplant recipients (HTR).

METHODS: Three hundred and twenty-two HTR out of 970 who had received their organ between December 1984 and July 2003 were analyzed for NMSC. Factors associated with tumor development including the different immunosuppressive (IS) modalities were evaluated. Besides triple combination immunosuppressive therapy, all allograft recipients had received induction therapy either with antithymocyte globulin, OKT3 or monoclonal anti-IL-2 receptor antibodies.

RESULTS: Median post-transplant follow-up for all patients was 74.18 months (minimum: 2.6, maximum: 224.8). The median time from transplantation until the excision of the first NMSC was 79.57 months (minimum: 2.69, maximum: 192.8). A total of 263 NMSC were excised in 73 patients. The cumulative incidence of developing a skin tumor increased from 7.3% after 5 years to 26.9% after 10 years and to 56.5% after 15 years. Older age at transplantation (P < 0.0001) and the presence of pre-cancerous skin conditions (P < 0.0001) were associated with an increased occurrence of NMSC. No significant difference in NMSC incidence was found when the different IS therapies were compared.

CONCLUSIONS: The cumulative incidence of NMSC in our cohort of HTR is comparable to published data on HTR adjusted according to the geographic location. Transplant patients with clinical evidence of pre-cancerous skin conditions have a higher degree of susceptibility for the development of NMSC and require particular dermatologic care.

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