Subsequent nonmelanoma skin cancers and impact of immunosuppression in liver transplant recipients

Pamela Funk-Debleds , Emilie Ducroux , Olivier Guillaud , José Ursic-Bedoya (1, 2) , Evelyne Decullier (3) , Mélanie Vallin , Sylvie Euvrard , Georges-Philippe Pageaux (1, 2) , Olivier Boillot (4) , Jérôme Dumortier

1 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
2 Département d'Hépato-Gastroentérologie et de Transplantation Hépatique [CHU Saint-Eloi]
3 HCL - Hospices Civils de Lyon
4 UCBL - Université Claude Bernard Lyon 1

BACKGROUND: Nonmelanoma skin cancers (NMSCs) are the most frequent cancers in solid organ transplant recipients, with a high rate of subsequent tumors. OBJECTIVES: To describe subsequent NMSCs in a large cohort of liver transplant~recipients (LTRs) with long follow-up and analyze the factors influencing it, including immunosuppressive regimen. METHODS: A total of 96 LTRs (76 male) with a personal post-transplant history of squamous cell carcinoma, basal cell carcinoma or Bowen's disease were included, with a median follow-up of 12.4~years (range, 1.5-27.8) after liver transplantation. RESULTS: The median follow-up after first NMSC was 6.4~years (range, 0.17-22.1). In all, 52 patients (53.1%) developed 141 subsequent NMSCs with a basal cell carcinoma-to-squamous cell carcinoma ratio of 1.8:1. The actuarial risk for development of a second NMSC was 13.7% at 1~year, 28.4% at 2~years, 49.4% at 5~years, 65.7% at 10~years, and 88.4% at 15~years. Multivariate analysis found that skin phototype I or II (vs III or IV) was a significant risk factor for development of a second NMSC (hazard ratio, 2.556; 95% confidence interval, 1.45-4.48; P~=~.001), whereas withdrawal of calcineurin inhibitors was significantly protective (hazard ratio, 0.358; 95% confidence interval, 0.142-0.902; P~=~.029). LIMITATIONS: Retrospective analysis. CONCLUSIONS: Subsequent NMSCs are very frequent in LTRs, and conversion from a calcineurin inhibitor-based immunosuppressive regimen to a mammalian target of rapamycin inhibitor/antimetabolite-based immunosuppressive regimen can reduce subsequent NMSCs.

Mots clés: Statistics; Nonparametric; Skin Neoplasms; predictive factors; Squamous Cell; incidence; phenotype; Immunocompromised Host; Age Distribution; immunosuppression; Sex Distribution; skin cancer; Humans; Female; Male; Retrospective Studies; Adult; Aged; Follow-Up Studies; Kaplan-Meier Estimate; Middle Aged; Survival Analysis; Cohort Studies; Carcinoma; Basal Cell; Liver Transplantation; Predictive Value of Tests; Proportional Hazards Models; Risk Assessment; Immunosuppressive Agents

Domaines: Sciences du Vivant [q-bio]

Pamela Funk-Debleds, Emilie Ducroux, Olivier Guillaud, José Ursic-Bedoya, Evelyne Decullier, et al.. Subsequent nonmelanoma skin cancers and impact of immunosuppression in liver transplant recipients. Journal of The American Academy of Dermatology, 2018, 79 (1), pp.84--91. ⟨10.1016/j.jaad.2017.12.063⟩. ⟨hal-02355791⟩