Transplants and Skin Cancer

Although organ transplants are relatively rare and only completed when medically necessary to save a life, patients that undergo these procedures are at higher risks for complications after the transplant. These complications can include the development of a range of conditions after the transplant, including the increased risk of developing skin cancer. In the United States alone approximately 75 people per day receive a transplant organ which can include a liver, kidney, heart and lung. In this same 24 hour period 20 people will die because a matching transplant organ was not available and one person every 11 minutes will be put on a waiting list for a transplant.1

Of the individuals that obtain an organ transplant the five year survival rate is very positive. This includes the rates of surviving for five years post transplant at:2

  • Lung 54.4%
  • Heart 74.9%
  • Liver 73.8%
  • Kidney 69.3%

Individuals that receive a heart transplant are between four and thirty percent more likely to develop skin cancer.  In addition the type of skin cancer developed also changes in incident based on the fact that the patient has had a transplant. There is up to a 65 fold increase in squamous cell carcinomas with basal cell carcinomas posing a 10 fold risk. Melanoma is also more prevalent with a 3.4 fold increase over the same population that has not undergone an organ transplant.3

Kaposi’s Sarcoma

The greatest increase or risk in developing cancer is in Kaposi’s sarcoma, which has an 84 fold increase in incidence if a transplant has occurred. Kaposi’s sarcoma is a tumor that is actually caused by the herpes virus and that appears on the skin as bright red inflamed looking moles or spotty colorations. Like the squamous and basal cell carcinomas as well as melanoma it is directly linked to the immunosuppressive drugs used to prevent the rejection of the transplanted organ in the body. It is considered to be like skin cancer in many aspects but can rapidly spread to the internal organs.4

It is important to realize this number appears so high because the occurrence of this condition outside of transplants is very rare. It is often associated with complications with patients with HIV and is most common in African and Mediterranean populations, affecting about 5-25% of the world’s population.

Risk Factors

Skin cancer risk factors are the same for transplant patients as for the general population, but there is the increasing risk that is caused by the use of the immunosuppressant drugs. The most common type of skin cancer found in transplant patients is squamous cell cancer which can be effectively treated if detected at early stages. Generally patients that have had transplants develop atypical types of squamous cell cancers that may pose additional difficulties in treating. The most important consideration is that these tumors often are much more fragile and may be much more prone to metastasis, or breaking off and spreading throughout the body. When this occurs cancers of the lymph nodes or other organs of the body may be more likely.

As a group, organ transplant patients have a higher risk of developing skin cancers that are faster growing, occur in multiple locations on the body, destroy more healthy tissue and be more likely to reoccur at the same location. Early detection is essential and even very young transplant patients need to routinely complete skin self-exams and doctor performed skin examinations on a regular basis.

According to studies, the likelihood of an organ transplant patient increases dramatically within the first 10 years after the transplant. The studies indicate that in 5 years there is a 5% chance of developing skin cancer and in 10 years up to a 10% chance. Typically the highest rates of skin cancer are seen in patients that have a heart or kidney transplant compared to liver or lung transplant recipients. This may be directly related to the type of specific immunosuppressive drug therapy regime that is used with these transplants.5

Immunosuppressive drug therapies are essential in the success of organ transplants. Doctors need to completely explain to patients the risks of skin cancers and the signs and symptoms of the development of skin cancer. In addition patients have to remain vigilant and proactive in completing self-examinations and reporting any skin abnormalities to their doctors and dermatologists as soon as they are noted.

Patients that have had an organ transplant need to be very careful about limiting any possible damage to their skin. Avoiding sun exposure by wearing protective clothing, even in cooler weather when the sun may not feel as hot, is essential. Any other risk factors such as the presence of atypical moles, genetic predisposition to skin cancers in the family or prior skin cancer treatment of a transplant patient needs to be taken into consideration.

For many patients, having an organ transplant is a matter of survival, and taking immunosuppressive drugs to ensure the success of the transplant is absolutely necessary. Working to prevent any additional risk of skin cancer is therefore critical to the patient. Working closely with a dermatologist and knowing the symptoms of basal and squamous cell skin cancers, particularly the variations common with transplant patients, will be an important part of ongoing health care.

References

1 The Need Is Real: Data. (n.d.). Retrieved from U.S Department of Health & Human Services : www.organdonor.gov/aboutStatsFacts.asp

2 Fast Facts. (n.d.). Retrieved from Ustransplant.org: www.ustransplant.org/fastfacts.aspx

3 What Transplant Patients Need to Know. (n.d.). Retrieved from University of California, San Francisco: www.dermatology.ucsf.edu/skincancer/transplant/

4 Kaposi Sarcoma. (n.d.). Retrieved from American Cancer Society: www.cancer.org/Cancer/KaposiSarcoma/DetailedGuide/kaposi-sarcoma-what-is-kaposi-sarcoma

5 Jensen, Petter. (1999). 5 Skin Cancer in kidney and heart trasnplant recipients and different long term immunosuppressive therapy regimes. Journal Of the American Academy of Dermatology , 177-186.