Journal
TRANSPLANTATION
Volume 87, Issue 11, Pages 1667-1671Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/TP.0b013e3181a5ce2e
Keywords
Renal transplantation; Nonmelanoma skin cancer; Predictive index; Screening
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Funding
- Engineering and Physical Sciences Research Council CASE studentship
- British Association of Dermatology Geoffrey Dowling award
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Background. Nonmelanoma skin cancer (NMSC) and associated premalignant lesions represent a major complication after transplantation, particularly in areas with high ultraviolet radiation (UVR) exposure. The American Society of Transplantation has proposed annual NMSC screening for all renal transplant recipients. The aim of this study was to develop a predictive index (PI) that could be used in targeted screening. Methods. Data on patient demographics, UVR exposure, and other clinical parameters were collected on 398 adult recipients recruited from the Princess Alexandra Hospital, Brisbane. Structured inter-view, skin examination, biopsy of lesions, and review of medical/pathologic records were performed. Time to presentation with the first NMSC was assessed using Cox's regression models an Kaplan-Meier estimates used to assess detection of NMSC during screening. Results. Stepwise selection identified age, outdoor UVR exposure, living in a hot climate, pretransplant NMSC, childhood sunburning, and skin type as predictors. The PI generated was used to allocate patients into three screening groups (6 months, 2 years, and 5 years). The survival curves of these groups were significantly different (P<0.0001). Jack-knife validation correctly allocated all patients into the appropriate group. Conclusion. We have developed a simple PI to enable development of targeted NMSC surveillance strategies.
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