Skin Cancer Risk in Transplant Patients: Study Finds Odds of Cancer Death Higher After Organ Transplant

Patients who undertake liver, kidney or other solid organ transplants are up to three times more likely to die from cancer than those in the general population, a study has found, suggesting that recipients need regular screening to catch malignancies early.

The study of more than 11,000 Ontario transplant patients found that almost one-fifth of the deaths in this group over a 20-year period were cancer-related, with skin cancers among those posing the most significant risk of death.

Of 3,068 deaths among patients who had kidney, liver, heart or lung transplants between 1991 and 2010, 603 were cancer-related, the study by the Institute for Clinical Evaluative Sciences and Toronto’s St. Michael’s Hospital concluded.

When researchers excluded patients with pre-transplant malignancies, the overall rate of cancer deaths was still twice that of the general population. Children who had received a transplant had a higher risk of dying from cancer than organ recipients over age 60.

The team, made up of researchers at the University of Toronto, found that the increased risk for cancer and cancer death was present in patients regardless of the organ being transplanted.

Researchers hypothesize transplant patients may not receive the most aggressive cancer treatment available because their immune systems have been suppressed to prevent rejection of the transplanted organ, though there is no evidence of that in their study.

As skin cancer topped the list of cancers that cause early death in patients, Baxter said patients knowing about the risks will definitely be beneficial. For the study, the researchers looked into more than 11,000 transplant patients in Ontario, Canada between 1991 and 2010, following them for 20 years.

The powerful medications “suppress the body’s response to cancer, so it can be more aggressive,” said Baxter, noting the median age of death was about five years after a transplant. “That’s very soon after the transplant, so one wonders if the immunosuppression kicks things into gear.”

Transplant patients diagnosed with cancer also may receive less aggressive treatment because of concerns about their having frailer health and a poorer ability to withstand the toxic side-effects of chemotherapy. Fears over potential organ rejection may also play a role, researchers speculate.

Baxter said skin cancers, both melanoma and non-melanoma cancers  are of particular concern for transplant patients, who were found to have a risk of dying from the disease 30 times higher than those in the general population.

“Skin cancer in this transplant patient population, non-melanoma skin cancer, it’s a different beast than it is in the general population,” explained Baxter. “I don’t want the message to go out to these transplant patients that they’re going to die of skin cancer because chances are that they’re not,” she said. “It’s an uncommon cause of death, but still it’s a much more aggressive cancer in this patient population.

“So it’s really important for them to get that message because there are a number of things that transplant patients can do to reduce their risk of developing and having a serious problem related to skin cancer.”