Comparison of skin cancer risk between renal transplant recipients and patients with glomerular diseases in rural Queensland

• Published in: The Australian journal of rural health Vol. 32; no. 2; pp. 249 - 262
• Main Authors: Thet, Zaw, Lam, Alfred King‐yin, Ng, Shu‐Kay, Aung, Soe Yu, Han, Thin, Ranganathan, Dwarakanathan, Newsham, Stephanie, Borg, Jennifer, Pepito, Christine, Khoo, Tien K.
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01-04-2024
• Subjects: Cancer; Cohort analysis; Diagnosis; glomerular disease; Health risks; Health services; High risk; Immunosuppression; Immunosuppressive agents; Kidney diseases; Kidney transplantation; Kidney transplants; Kidneys; Medical diagnosis; Melanoma; non‐melanoma cutaneous carcinoma; renal transplant; Risk; Rural areas; Rural communities; Skin cancer; Skin carcinoma; Skin melanoma; Statistical analysis; Subgroups; Tests; Transplantation; Queensland Australia; Australia; non‐melanoma cutaneous carcinoma; skin cancer; glomerular disease; renal transplant
• ISSN: 1038-5282; 1440-1584
• DOI: 10.1111/ajr.13081

Introudction
There is increased risk of skin cancer in patients with gloermular disease or those with renal transplant.
Objectives
To compare the risk of skin cancer between kidney recipients (KTRs) and patients with glomerular disease (GD).
Design
The cohort comprised patients with KTRs (n = 61) and GD (n = 51) in Central and Central West Queensland, Australia. A quantitative cohort study was undertaken to study the risk of skin cancer in rural communities between two subgroups of patients with kidney diseases in relationship to immunosuppression. Statistical analyses of the differences in incidence of skin cancers between the two groups were done by chi‐square test, Fisher's exact test, independent t‐test and McNemar's test.
Findings
KTRs with non‐melanoma skin carcinoma (NMSC) increased significantly after treatment with immunosuppressants (pre‐transplantation, n = 11 [18.0%], post‐transplantation, n = 28 [45.9%]; p < 0.001). There were no differences in number of patients with NMSC observed in the GD group (pre‐diagnosis, n = 6 [11.8%], post‐diagnosis, n = 7 [13.7%]; p = 1.000). Compared to the risks at 1 year post‐immunosuppressants, the incidence of NMSC of KTRs increased significantly at 3 years (20.3% vs. 35.4%, p < 0.001) and 5 years (20.3% vs. 62.2%, p < 0.001) post‐immunosuppressants, whereas the increased incidence of NMSC was observed only at 5 years (2.1% vs. 11.8%, p = 0.012) in the GD cohort. The mean cumulative number of NMSC in KTRs increased significantly at 3 years (p = 0.011), and 5 years (p = 0.001) post‐immunosuppressants, compared to the risks at 1 year post‐immunosuppressants, however, no differences were noted in the GD cohort.
Discussion
Immunosuppressants increased the risk of NMSC in KTRs. The increased risk is likely dependent on the intensity and duration of immunosuppressants.
Conclusion
In patients with a high risk of NMSC, reducing skin cancer risk should be considered in conjunction with the optimisation of treatment.