Type of Organ Transplanted Impacts the Risk and Presentation of Cutaneous Squamous Cell Carcinoma in Transplant Recipients

Objectives: Transplant immunosuppression increases the risk of cutaneous squamous cell carcinoma by 65- to 200-fold. Our objective was to investigate the impact of the type of organ transplanted on the risk and presentation of cutaneous squamous cell carcinoma. Materials and Methods: The retrospective database of the Duke University Health System was queried to identify patients who underwent an organ transplant from 1996 to 2016. Data regarding transplant outcomes, cutaneous squamous cell carcinoma, immunosuppressive regimens, and survival were recorded. We used chi-square tests, analysis of variance, and unpaired t tests to compare the incidence and presentation of cutaneous squamous cell carcinoma among organ types. Results: Of 3652 renal, hepatic, and cardiothoracic transplant patients identified, 142 patients developed at least 1 cutaneous squamous cell carcinoma. The incidence of cutaneous squamous cell carcinoma varied by type of organ transplanted, with 46 of 1684 (2.7%) renal transplant patients developing cutaneous squamous cell carcinoma, 33 of 804 (4.1%) hepatic transplant patients, and 63 of 1164 (5.4%) cardiothoracic transplant patients over the median follow-up time of 6.5 years. Incidence in the renal transplant versus the cardiothoracic transplant group was significantly different (P < .001). The time to presentation of cutaneous squamous cell carcinoma varied significantly by group, with the renal cohort presenting at 3.8 years compared with at 2.4 years in the cardiothoracic group and 2.1 years in the hepatic group (P < .001). Conclusions: The type of organ transplanted confers a unique risk and presentation of cutaneous squamous cell carcinoma.