Predicting Skin Cancer Development after Liver Transplant

Introduction: As the number of solid organ transplants (SOTs) continues to increase and post-transplant therapies improve, SOT recipients (SOTRs) live longer and thus, are increasingly affected by post-transplant sequala such as skin cancer. Research investigating risk factors associated with skin cancer development in SOTRs has largely been conducted in kidney recipients. Methods: We performed a retrospective chart review of SOTRs seen by dermatology from January 1, 2012 – June 1, 2022. Data was analyzed using Pearson chi-square testing and Classification and Regression Tree (CART) modeling. Results: Of 530 patients meeting inclusion criteria, 80 received liver transplants. Among liver recipients, a total of 155 skin cancers and five recurrences developed following transplant among 37 patients (46.25%). Patients who developed skin cancer were Caucasian (94.6%, p-value=0.186) and were significantly more likely to be male (78.4%, p-value=0.045) and former smokers (59.5%, p-value=0.038). CART showed age greater than 43 years was the biggest predictor for later skin cancer development. Patients most frequently developed squamous cell carcinoma (60.87%) of the head and neck (51.35%) or upper extremities (29.73%). Conclusion: Risk factors associated with skin cancer development in liver transplant recipients include increased age at transplant, white race, male sex, and smoking status. Stratification of referrals to dermatology based on these factors should be considered.