Skin Cancer Risk Stratification and Outcomes in Swedish Solid Organ Transplant Recipients

Solid organ transplant recipients (SOTRs) have an increased risk of cutaneous malignancies due to long-term immunosuppressive therapy. To evaluate a risk stratification model for follow-up of SOTRs at Karolinska University Hospital, Sweden, in which SOTRs are categorized based on skin cancer risk (low, intermediate, high), 395 patients were followed from 2010 until 2023 in this retrospective, real-world cohort. Over a third of SOTRs (n=151, 38.23%) developed invasive skin cancer. High-risk SOTRs (n=30) displayed the shortest time to first post-transplant invasive skin cancer, followed by intermediate- (n=112) and low-risk SOTRs (n=253) (p<0.0001). In adjusted analyses, intermediate- and high-risk SOTRs had 5.98-fold (95% confidence intervals (CI): 4.05-8.34) and 11.90-fold (95% CI: 7.02-20.19) higher hazard of invasive skin cancer compared to low-risk SOTRs, respectively. Intermediate- and high-risk SOTRs had 1.53-fold (95% CI: 1.03-2.27) and 1.97-fold (95% CI: 1.10-3.54) higher hazard of death compared to low-risk SOTRs. Ten patients developed metastasis and four died of skin cancer. This model serves as a dynamic tool for follow-up and provides time-to-skin-cancer discrimination between intermediate- and low-risk SOTRs. The findings illustrate the potential utility of risk-based stratification of SOTR follow-up and secondary prevention of cutaneous malignancies, potentially improving survival outcomes in this patient group.