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Transpl Int. 2019 Aug 19. doi: 10.1111/tri.13493. [Epub ahead of print]

Predicting skin cancer in organ transplant recipients: development of the SUNTRAC screening tool using data from a multicenter cohort study.

Author information

1
Division of Dermatology, Department of Internal Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA.
2
Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA.
3
Department of Internal Medicine, Kaiser Permanente, San Francisco, CA, USA.
4
Division of Abdominal Transplantation, Department of Surgery, Stanford University, Palo Alto, CA, USA.
5
Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
6
Women's College Research Institute, Toronto, ON, Canada.
7
Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
8
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.

Abstract

Skin cancer is a common post-transplant complication. In this study, the Skin and Ultraviolet Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) was developed to stratify patients into risk groups for post-transplant skin cancer. Data for this study were obtained from the Transplant Skin Cancer Network (TSCN), which conducted a multicenter study across 26 transplant centers in the United States. In total, 6340 patients, transplanted from 2003 and 2008, were included. Weighted point values were assigned for each risk factor based on beta coefficients from multivariable modeling: white race (9 points), pretransplant history of skin cancer (6 points), age ≥ 50 years (4 points), male sex (2 points), and thoracic transplant (1 point). Good prognostic discrimination (optimism-corrected c statistic of 0.74) occurred with a 4-tier system: 0-6 points indicating low risk, 7-13 points indicating medium risk, 14-17 points indicating high risk, and 18-22 points indicating very high risk. The 5-year cumulative incidence of development of skin cancer was 1.01%, 6.15%, 15.14%, and 44.75%, for Low, Medium, High, and Very High SUNTRAC categories, respectively. Based on the skin cancer risk in different groups, the authors propose skin cancer screening guidelines based on this risk model.

KEYWORDS:

epidemiology; guidelines; post-transplant malignancy; screening; skin cancer; solid organ transplantation

PMID:
31423648
DOI:
10.1111/tri.13493

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