[Skin cancer in patients submitted to organ transplantation: a growing problem]

External Validation of the Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) in a Large European Solid Organ Transplant Recipient Cohort

Importance

The Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) tool has been developed in the US to facilitate the identification of solid organ transplant recipients (SOTRs) at a higher risk of developing skin cancer. However, it has not yet been validated in populations other than the one used for its creation.

Objective

To provide an external validation of the SUNTRAC tool in different SOTR populations.

Design, Setting, and Participants

This retrospective external validation prognostic study used data from a prospectively collected cohort of European SOTRs from transplant centers at teaching hospitals in the Netherlands (1995-2016) and Spain (2011-2021). Participants were screened and followed up at dermatology departments. Data were analyzed from September to October 2021.

Main Outcomes and Measures

The discrimination ability of the SUNTRAC tool was assessed via a competing risk survival analysis, cumulative incidence plots, and Wolbers concordance index. Calibration of the SUNTRAC tool was assessed through comparison of projected skin cancer incidences. Skin cancer diagnoses included squamous cell carcinoma, basal cell carcinoma, melanoma, and Merkel cell carcinoma.

Results

A total of 3421 SOTRs (median age at transplant, 53 [quartile 1: 42; quartile 3: 62] years; 2132 [62.3%] men) were assessed, including 72 Asian patients (2.1%), 137 Black patients (4.0%), 275 Latinx patients (8.0%), 109 Middle Eastern and North African patients (3.2%), and 2828 White patients (82.7%). With a total of 23 213 years of follow-up time, 603 patients developed skin cancer. The SUNTRAC tool classified patients into 4 groups with significantly different risks of developing skin cancer during follow-up. Overall, the relative rate for developing skin cancer estimated using subdistribution hazard ratios (SHRs) and using the low-risk group as the reference group, increased according to the proposed risk group (medium-risk group: SHR, 6.8 [95% CI, 3.8-12.1]; P < .001; high-risk group: SHR, 15.9 [95% CI, 8.9-28.4]; P < .001; very-high-risk group: SHR, 54.8 [95% CI, 29.1-102.9]; P < .001), with a concordance index of 0.72. Actual skin cancer incidences were similar to those predicted by the SUNTRAC tool (5-year skin cancer cumulative incidence for medium-risk group: predicted, 6.2%; observed, 7.0%).

Conclusions and Relevance

The findings of this external validation prognostic study support the use of the SUNTRAC tool in European populations for stratifying SOTRs based on their skin cancer risk and also detecting patients at a high risk of developing skin cancer. This can be helpful in prioritizing and providing better screening and surveillance for these patients.

Sun Protection in Renal Transplant Recipients: Urgent Need for Education

BACKGROUND

Renal transplant recipients (RTR) are considered as a high-risk group of skin cancer development.

OBJECTIVE

The aim of the present studywas to find out the knowledge about the harmfulness of sunlight and the methods of sun protection among RTR.

MATERIAL AND METHODS

151 RTR (91 males and 60 females) were surveyed using a specially designed questionnaire.

RESULTS

The knowledge about the danger of sunlight exposure among RTR appeared to be very unsatisfactory. Only 40.4% of patients knew that the development of skin cancer is connected with the exposure to sunlight. Moreover, only 68.2% of investigated individuals considered RTR as a high-risk group of skin cancer development. Although 74.8% of patients were informed about the necessity of sun protection, only 11.3% could explain what the number of the SPF (sun protection factor) means. Females significantly more often knew that RTR are especially predisposed to the development of skin cancers (p = 0.0001) and significantly more frequently could explain what the SPF number means (p = 0.006). 72.8% of RTR (females significantly more often, p = 0.02) made efforts to avoid sunlight irradiation. However, only 5.3% of the examined patients routinely used creams with SPF (females significantly more often, p < 0.0001). More than a half of the patients (62.3%) did not apply any sun protection.

CONCLUSIONS

The present study revealed the urgent necessity of education concerning the harmfulness of sunlight and the methods of sun protection among RTR. Moreover, it is postulated that every patient should be routinely examined by a dermatologist in a dedicated transplant patient clinic.