The course of skin cancer after retransplantation in organ-transplant recipients who have already developed posttransplant skin cancer has not been assessed.
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.
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.
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.
Candidates for retransplantation with prior posttransplant squamous cell cancer have a high risk of aggressive cancer if they have fair skin, a history of multiple tumors, receive azathioprine or T cell-depleting antibodies, and have delayed revision of immunosuppression.
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.
Received 11 July 2016. Revision received 5 December 2016.
Accepted 9 December 2016.
This work was supported by a grant from the French Society of Dermatology.
The authors declare no conflicts of interest.
S.E. and J.D. conceived the idea of the project. E.D., C.M., E.D. and S.E. participated in the analysis and interpretation of data. C.M., E.D. and S.E. participated in the study design. E.D., C.M., J.N.B.B., A.B., M.v.E., C.L., C.F., E.M., C.L., P.J., S.E. and J.D. participated in acquisition of the data. All authors critically revised the article. C.M. and E.D. performed the statistical analysis.
Correspondence: Emilie Ducroux, MD, Department of Dermatology, Edouard Herriot Hospital Group, 5 Place d'Arsonval 69437 Lyon Cedex 03, France. (firstname.lastname@example.org).