Increased Risk for Ocular Surface Neoplasia in Recipients of Solid Organ Transplant

Recipients of solid organ transplants (SOT) undergo long-term immunosuppressive therapy, placing them at a high risk for developing skin cancer. Given that the conjunctiva and skin share key risk factors for neoplasia, we conducted a study to examine the association between immunosuppressive agents used in recipients of SOT and risk of ocular surface neoplasia (OSSN).

Retrospective cohort study using the TriNetX US Collaborative Network.

We included individuals ≥18 years of age receiving oral or intravenous tacrolimus, cyclosporine, sirolimus, mycophenolate mofetil or sodium, everolimus, or azathioprine. Individuals without subsequent ophthalmology follow-up or with prior OSSN diagnoses were excluded. The control cohort included individuals with multiple ophthalmology follow-ups, no prior OSSN diagnoses, and no exposure to the medications of interest.

Propensity score matching (1:1) was used to control for covariates such as demographics and known risk factors of OSSN. Odds ratios with 95% confidence intervals were calculated using univariate analysis to compare outcomes. Multiple sub analyses were performed, in which we required additional exposure to the medications, controlled for common autoimmune disorders, or excluded all recipients of SOT.

Risk of a new OSSN diagnosis during the study period.

After matching, 43 580 individuals were included for analysis. There were 46 (0.11%) new cases of OSSN in the exposure cohort and 20 (0.05%) cases in the control cohort. Those on immunosuppressive therapy had a 2.3 times higher risk of developing OSSN (odds ratio [OR] 2.30 [95% CI 1.36 to 3.89]) during the study period. Sensitivity analyses requiring additional instances of medication exposure (OR 3.67 [95% CI 1.94 to 6.95]) or controlling for other indications of immunosuppressive therapy (OR 1.70 [95% CI 1.06 to 2.74]) showed consistent results. Excluding all recipients of SOT resulted in no significant association with OSSN (OR 1.31 [95% CI 0.64 to 2.69]).

Recipients of SOT who underwent immunosuppressive therapy experienced a significantly increased risk of developing OSSN. Appropriate ophthalmological monitoring for OSSN in these populations is recommended.