Risk of Aggressive Skin Cancers Following Kidney Retransplantation in Patients With Previous Posttransplant Cutaneous Squamous Cell Carcinomas: A Retrospective Study of 53 Cases.

Background: The course of skin cancer after retransplantation in organ-transplant recipients who have already developed posttransplant skin cancer has not been assessed. Methods: 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 end-point was the occurrence of aggressive cutaneous SCC after the second transplantation. Secondary end-points 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. Results: The first SCC developed in 47 patients with a functional graft and in 6 after return to dialysis. After the first transplantation, 17 patients (33.3%) 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 patients (26.4%) 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. Conclusion: Candidates to retransplantation with a history of post-transplant 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. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2iM8to4