NON-MELANOMA SKIN CARCINOMA BEFORE AND AFTER EXPOSURE TO IMMUNOSUPPRESSIVE TREATMENT AMONG PATIENTS WITH GLOMERULAR DISEASE AND RENAL TRANSPLANT RECIPIENTS

THET Z1,2, LAM A1,3, NG S1, RANGANATHAN D1,4, AUNG S5,6, HAN T2,6, BORG J2, PEPITO C2, NEWSHAM S2, KHOO T1,7

1School of Medicine and Dentistry, Griffith University, , Australia, 2Department of Nephrology, Central Queensland, Queensland, Australia, 3Pathology Queensland, Gold Coast University Hospital, Australia, 4Department of Nephrology, Metro North Hospital and Health Service, Brisbane, Queensland, Australia, 5Department of Oncology, Central Queensland, Australia, 6School of Medicine, University of Queensland, Rockhampton, Queensland, Australia, 7School of Medicine, University of Wollongong, New South Wales, Australia

Aims: To compare the risk of non-melanoma skin cancer (NMSC) before and after exposure to immunosuppressants between patients with glomerular diseases (GD) and renal transplant recipients (RTRs).

Background:       There are currently no studies that compare the incidence of NMSC between patients with GD treated with immunosuppressants and RTRs. Patients with GD are often treated with less intense immunosuppressive therapy for a shorter duration compared to RTRs.

Methods: In Central and Central West Queensland, a region known to have a high ultraviolet index, a retrospective cohort study was undertaken among adult patients with GD and RTRs with first-time kidney graft, who attended renal clinic from 01/01/2019 to 31/12/2019.

Results: The cohort comprised of 51 patients with GD and 61 RTRs. The median duration of follow-up were 52.5 months {interquartile range (IQR) 29.8-81.8} and 74.0 months (IQR 44.5-110.5), respectively (p=0.088). After exposure to immunosuppressants, 26 NMSCs were present in 7 (13.7%) of 51 GD patients.  In contrast, 318 NMSCs were noted in 28 (45.9%) of the 61 RTRs after renal transplant. The total number of RTRs with NMSC increased significantly after treatment with immunosuppressants {N=11 (18.0%) and N=28 (45.9%), respectively in pre-and post-transplantation, p=0.003}. There was no significant difference observed in the GD group {pre-diagnosis N= 6 (11.8%), post-diagnosis N=7 (13.7%), p=0.186}. The median onset of SCC, BCC and in-situ SCC were 30.0 months (IQR 25.08-85.01), 23.0 months (IQR 23.25-84.59), and 28.0 months (IQR 23.25-84.59), respectively after transplant surgery. NMSC arose predominantly on chronically sun-exposed skin in both cohorts.

Conclusions:  Immunosuppressive treatment increases the risk of NMSC in RTRs, however its role in in GD patients was not demonstrated in our cohort.


Biography:

Dr Thet is a nephrologist working in Central Queensland. He  affiliates with Griffith University and Queensland University as an associate professor. His focus of research is immunosuppressant related malignancy in patients with glomerular disease and renal transplant recipients.

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