Heart transplant recipients at increased risk for skin cancers

Patients who received heart transplants had an elevated risk for developing skin cancers, including squamous cell carcinomas and basal cell carcinomas, according to a retrospective review of patient medical records conducted at the Mayo Clinic.

Previous research has shown that all solid organ transplant patients are at increased risk for skin cancers. There has been extensive documentation of risk among renal transplant patients. However, heart transplant patients are twice as likely to have skin cancer compared with renal transplant patients. In addition, little data are available on incidence, tumor burden and risk factors in heart transplant patients.

To gather more data, researchers examined data from 312 patients who received heart transplants at the Mayo Clinic between 1988 and 2006. Among these patients there were 1,395 new skin cancers in 2,097 person-years; 46.4% of patients had developed skin cancer during 19 years of follow-up.

There were 1,236 squamous cell carcinomas (89%), 151 basal cell carcinomas (11%), five malignant melanomas (<1%) and three other types. At five years, 20.4% of patients had a skin cancer of any kind; at 10 years, the rate was 37.5%, and at 15 years, the rate was 46.4%.

In multivariate analysis, factors linked to increased risk for squamous cell carcinomas were post-transplant nonskin cancer (P=.007), increased age at transplant (P<.001) and heart transplant due to idiopathic heart failure compared with all other causes (P=.04).

Older age at transplant (P<.001), post-transplant infection with herpes simplex virus (P=.02) and mycophenolate mofetil use (P=.02) were factors linked to elevated risk for basal cell carcinomas, in multivariate analysis.

“Vigilant sun protection practices, skin cancer education, regular skin examinations and daily vitamin D supplementation are appropriate interventions in these high risk heart transplant patients,” the researchers wrote.

Brewer JD. Arch Dermatol. 2009;145:1391-1396.