Kidney transplant recipients are known to have an increased risk of developing skin cancer and of dying from skin cancer compared with the general population, in part because of long-term immunosuppression. This study sought to quantify skin cancer mortality among kidney transplant recipients in Australia and New Zealand over a 30-year period (1990–2019), and to describe excess mortality relative to the general population by sex, age at death, calendar decade and geographic region.
The investigators conducted a population-based cohort study by linking records from the Australia and New Zealand Dialysis and Transplant Registry with national death registers in Australia and New Zealand for the years 1990–2019. Deaths were identified using International Classification of Diseases 10th Revision codes for melanoma (C43), keratinocyte cancer (KC; C44) and carcinoma in situ (D04). Absolute mortality rates were calculated per 100,000 person-years (PY) of follow-up. Indirect standardization produced standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) comparing kidney transplant recipients with the general population, stratified by sex, age at death, decade of death and New Zealand or Australian state.
The analysis included 21,503 individuals who received their first kidney transplant between 1990 and 2019. The total follow-up time amounted to 212,317 person-years. Over this follow-up period there were 251 deaths attributed to skin cancer.
Across the cohort the absolute mortality rate from any skin cancer was reported as 118.2 per 100,000 PY (95% CI 104.1–134.2). For specific categories the observed rates were: 38.6 per 100,000 PY for melanoma (95% CI 31.1–48.0) and 79.6 per 100,000 PY for keratinocyte cancer (KC) (95% CI 68.5–92.6).
When compared with the general population using indirect standardization, kidney transplant recipients showed markedly higher skin cancer mortality. The overall SMR for skin cancer death was 11.1, indicating an 11-fold excess mortality. For causespecific mortality, the SMR was 4.5 for melanoma and 34.5 for KC, demonstrating particularly large excess mortality for non-melanoma keratinocyte cancers.
Excess skin cancer mortality among kidney transplant recipients was observed in both sexes and across all age groups and residential areas assessed. The elevated risk persisted across decades of follow-up between 1990 and 2019. Geographic analyses identified the greatest excess mortality in regions with high ultraviolet radiation (UVR) indices: Queensland (SMR 14.8; 95% CI 11.7–18.8) and Western Australia (SMR 13.1; 95% CI 8.7–19.7) in Australia, and New Zealand overall (SMR 11.0; 95% CI 8.3–14.6).
The findings indicate that people who receive kidney transplants face substantially higher risks of dying from skin cancer than the general population, most markedly for keratinocyte cancer. Excess mortality affected all demographic groups and regions studied, with pronounced effects in high-UVR areas. Based on these results the authors recommend enhanced surveillance and rapid entry into treatment pathways for transplant recipients with suspected skin cancer, and they emphasize the importance of preventive measures to reduce skin cancer development in this high-risk population.
People who have had a kidney transplant face higher rates of skin cancer and skin cancer death, largely related to the immunosuppressive treatment needed to prevent transplant rejection. In this binational, population-based study of 21,503 first kidney transplant recipients from 1990–2019, transplant recipients were about 11 times more likely to die of skin cancer than the general population. The excess risk was approximately 4-fold for melanoma and about 34-fold for non-melanoma keratinocyte cancer. Elevated mortality was seen for men and women, across age groups and decades, and was highest in high-UVR regions such as Queensland and Western Australia. The study underscores the need for targeted prevention, ongoing surveillance and prompt treatment for skin cancers in kidney transplant recipients.
Note: The abstract and plain language summary provided the data included here. Details beyond those reported in the source abstract—such as specific immunosuppressive regimens, staging at diagnosis, or time from transplant to skin cancer death—were not reported in the source and therefore are not described.