Cohort and nested case-control study of cutaneous squamous cell carcinoma in solid organ transplant recipients, by medication

Background: Knowledge is needed about the risk of cutaneous squamous cell carcinoma (cSCC) in solid organ transplant recipients (SOTRs) using contemporary immunosuppressive regimens. Objective: Evaluate the risk of cSCC in relation to medications used by SOTRs. Methods: The cohort and nest case-control study included 3308 SOTRs and 65,883 persons without transplantation during 2009-2019. Incident cSCC was identified from pathology data, and medications were identified from pharmacy data. Adjusted hazard ratios and 95% confidence intervals (CIs) were estimated using Cox proportional hazards analysis, with voriconazole examined as a time-dependent variable. Results: The annual incidence of cSCC was 1.69% in SOTRs and 0.30% in persons without transplantation. The adjusted hazard ratio of cSCC associated with lung transplant was 14.83 (95% CI, 9.85-22.33) for lung and 6.53-10.69 for other organs. Risk in Latinx persons was higher than in other non-White groups. Among lung recipients, the hazard ratio was 1.14 for each month of voriconazole use (95% CI, 1.04-1.26). Azathioprine use for >= 7 months, relating to mycophenolate mofetil intolerance, was associated with a 4.22-fold increased risk of cSCC (95% CI, 1.90-9.40). Belatacept and other immunsuppressive medications were not associated with risk. Limitation: The number of events was somewhat small. Conclusions: The knowledge of risks and benefits in diverse patients can translate to improvements in care.

Automated summary

This study aimed to evaluate the risk of cutaneous squamous cell carcinoma (cSCC) in solid organ transplant recipients (SOTRs) using immunosuppressive medications. The results showed that the annual incidence of cSCC was higher in SOTRs compared to persons without transplantation. Lung transplant and the use of voriconazole were associated with an increased risk of cSCC, while belatacept and other immunosuppressive medications were not.