Pancreas Transplant Recipients Research Articles

The role of donor hypertension and angiotensin II in the occurrence of early pancreas allograft thrombosis

BackgroundAbout 10–20% of pancreas allografts are still lost in the early postoperative period despite the identification of numerous detrimental risk factors that correlate with graft thrombosis.MethodsWe conducted a multicenter study including 899 pancreas transplant recipients between 2000 and 2018. Early pancreas failure due to complete thrombosis, long-term pancreas, kidney and patient survivals were analyzed and adjusted to donor, recipient and perioperative variables using a multivariate cause-specific Cox model stratified to transplant centers.ResultsPancreas from donors with history of hypertension (6.7%), as well as with high body mass index (BMI), were independently associated with an increased risk of pancreas failure within the first 30 post-operative days (respectively, HR= 2.57, 95% CI from 1.35 to 4.89 and HR= 1.11, 95% CI from 1.04 to 1.19). Interaction term between hypertension and BMI was negative. Donor hypertension also impacted long-term pancreas survival (HR= 1.88, 95% CI from 1.13 to 3.12). However, when pancreas survival was calculated after the postoperative day 30, donor hypertension was no longer a significant risk factor (HR= 1.22, 95% CI from 0.47 to 3.15). A lower pancreas survival was observed in patients receiving a pancreas from a hypertensive donor without RAAS (Renin Angiotensin Aldosterone System) blockers compared to others (50% vs 14%, p < 0.001). Pancreas survival was similar among non-hypertensive donors and hypertensive ones under RAAS blockers.ConclusionDonor hypertension was a significant and independent risk factor of pancreas failure. The well-known pathogenic role of renin-angiotensin-aldosterone system seems to be involved in the genesis of this immediate graft failure.

Survival Advantages of Pancreas Transplantation

The field of transplantation has provided tremendous progress to diabetic patients. One way to objectify this development is to determine the survival advantage of transplantation in the 4 diabetic recipient categories: simultaneous pancreas and kidney transplantation (SPK), pancreas after kidney transplantation (PAK), pancreas transplantation alone (PTA), and kidney transplantation alone (KTA). Over a 21-year time period, from January 1, 2000, to May 31, 2021, the IPTR/UNOS collected information about listing and transplant outcome of diabetic patients. A total of 212,049 patient records were reviewed: 89,579 recipients who underwent pancreas and/or kidney transplantation and 122,470 patients who were placed on the waiting list and are still waiting or were removed from the waitlist due to deteriorating health or death. To determine the survival advantage of pancreas transplantation, patient survival on the waiting list versus after transplantation was defined as the primary outcome. Over the 21-year time period, pancreas and/or kidney transplantation in all 4 diabetic recipient categories saved a total of 273,843 life-years. On average, 11.7 life-years per patient were saved in the SPK category, 6.4 life-years in the PTA category, 6.3 life-years in the PAK category, and 6.6 life-years in the KTA category. The survival advantage of pancreas and/or kidney transplant recipients was highly significant compared to diabetic patients still waiting for transplantation. The survival advantage was higher for patients with type 1 vs. type 2 diabetes mellitus. The significant survival advantage of PTA recipients versus patients on the waiting list justifies the argument for pre-emptive pancreas transplantation, i.e., before the development of end-stage renal disease. Given the survival advantage as evidenced in 273,843 life-years saved, pancreas transplantation should be more widely applied, and pancreas donation encouraged.

O236: The Impact of HLA Matching on Pancreas and Simultaneous Pancreas-Kidney (SPK) Transplantation Outcomes

Abstract Background This study evaluates the controversial impact of human leukocyte antigen (HLA) matching on pancreas graft survival and acute rejection. Methods Utilizing a large-scale multi-center database (UNOS/OPTN), we identified 8,005 pancreas and 7,850 simultaneous pancreas-kidney (SPK) transplant patients. Patients were classified into HLA matched (0-3 mismatches) and mismatched (4-6 mismatches) groups. Subsequently, utilizing multivariate Cox analysis, we evaluated risk-adjusted outcomes, represented through Kaplan-Meier survival curves. We also examined differences in graft survival and acute rejection based on transplant type (SPK or pancreas alone) within the same HLA mismatch group. Findings There were no significant differences in pancreas graft survival or acute rejection observed between HLA matched and mismatched groups for both pancreas and SPK transplant recipients (P > 0.05). However, among HLA mismatched patients, pancreas patients exhibited a 629-day lower pancreas graft survival than SPK patients (3774 vs. 4403 days, P < 0.001) and had a higher likelihood of experiencing acute rejection post-transplant (P < 0.001). Similarly, within the HLA matched groups, pancreas patients showed lower graft survival compared to SPK patients (3774 vs. 4403 days, P < 0.001); however, their acute rejection rates did not significantly differ (P > 0.05). Interpretation Although HLA matching was not associated with improved pancreas graft survival or a reduction in acute rejection, the results suggest a potential protective effect of the kidney in SPK transplants against the consequences of HLA mismatching. This underscores the clinical significance of considering the kidney component in donor-recipient matching for pancreas transplantation.

Tixagevimab/cilgavimab for the prevention of COVID-19 in solid organ transplant recipients.

Tixagevimab/cilgavimab (tix/cil) received emergency use authorization in December 2021 for pre-exposure prophylaxis against COVID-19 in moderately to severely immunocompromised patients. Our study aimed to describe the incidence of COVID-19 infection and assess the immunologic risks associated with tix/cil in kidney, pancreas, liver, and heart transplant recipients. Retrospective chart review was completed to provide descriptive analysis. Outcomes data included COVID-19 infection, severity of COVID-19 infection, graft function, and rejection. Safety outcomes included cardiovascular (CV) and hypersensitivity events post tix/cil administration. A total of 410 transplant patients were included in the analysis: 20 heart, 92 liver, 243 kidney, 25 simultaneous pancreas/kidney, 23 simultaneous liver/kidney, and seven simultaneous heart/kidney. Twenty-seven (6.5%) patients tested positive for COVID-19 via PCR or antigen test post tix/cil. No apparent difference was observed in patients testing positive for COVID-19 by type of organ transplant (p=.122). Twenty-five of the 27 patients testing positive for COVID-19 reported symptomatic infection, only nine of whom were hospitalized. No patients were mechanically ventilated and no deaths due to COVID-19 occurred. No significant changes in graft function were observed. Clinically significant rejection was diagnosed and treated in four patients. COVID-19 breakthrough infection rates remained low in immunocompromised solid organ transplant recipients who received tix/cil. No significant immunologic risks were observed.

Tacrolimus's Time Below Therapeutic Range Is Associated With Acute Pancreatic Graft Rejection and the Development of De Novo Donor-specific Antibodies.

Tacrolimus is pivotal in pancreas transplants but poses challenges in maintaining optimal levels due to recipient differences. This study aimed to explore the utility of time spent below the therapeutic range and intrapatient variability in predicting rejection and de novo donor-specific antibody (dnDSA) development in pancreas graft recipients. This retrospective unicentric study included adult pancreas transplant recipients between January 2006 and July 2020. Recorded variables included demographics, immunosuppression details, HLA matching, biopsy results, dnDSA development, and clinical parameters. Statistical analysis included ROC curves, sensitivity, specificity, and predictive values. A total of 131 patients were included. Those with biopsy-proven acute rejection (BPAR, 12.2%) had more time (39.9% ± 24% vs. 25.72% ± 21.57%, p = 0.016) and tests (41.95% ± 13.57% vs. 29.96% ± 17.33%, p = 0.009) below therapeutic range. Specific cutoffs of 31.5% for time and 34% for tests below the therapeutic range showed a high negative predictive value for BPAR (93.98% and 93.1%, respectively). Similarly, patients with more than 34% of tests below the therapeutic range were associated with dnDSA appearance (38.9% vs. 9.4%, p = 0.012; OR 6.135, 1.346-27.78). In pancreas transplantation, maintaining optimal tacrolimus levels is crucial. Suboptimal test percentages below the therapeutic range prove valuable in identifying acute graft rejection risk.

Validation of the Back-table Graft Arterial Anastomosis between the Splenic Artery and Superior Mesenteric Artery: Arterial Complications after a 21-year Single-center Experience of Pancreas Transplantation.

To determine the role of the arterial splenomesenteric anastomosis (ASMA) vascular reconstruction technique in terms of arterial vascular complications in pancreas transplant (PT) recipients. The ASMA technique was first described in 1992 by Hospital Clínic Barcelona group. Regardless that the iliac Y-graft technique is the most frequently used worldwide, evidence of arterial complications and implications of using a different back-table reconstruction is conspicuously absent in the literature. Descriptive review of 407 PTs performed at a single center (1999-2019) by analyzing the type of arterial reconstruction technique, focusing on ASMA. The endpoints were the management of arterial complications and long-term patient and graft survival. ASMA was performed in 376 cases (92.4%) and a Y-graft in 31 cases (7.6%). A total of 34 arterial complications (8.3%) were diagnosed. In the ASMA group (n=30, 7.9%) they comprised: 15 acute thrombosis; 4 stenosis; 1 pseudoaneurysm and 10 diverse chronic arterial complications while in the Y-graft group (n=4, 12.9%) 3 acute thrombosis and 1 chronic artery-duodenal fistula occurred. Graft salvage was achieved in 16 patients (53.3%) from the ASMA group and in 2 (50%) from the Y-graft. After a median follow-up of 129.2 (IQR 25-75%, 77.2 -182) months the overall graft and patient survival for the whole cohort at 1, 5, and 10 years was 86.7%, 79.5%, 70.5%, and 98.5%, 95.3%, 92.5%, respectively. The ASMA proves to be a safe and more easily reproducible technique and should therefore be considered for first-line back-table reconstruction in the PT population.

Risk factors and outcomes of persistent post-transplant hypotension among simultaneous pancreas and kidney transplant recipients.

The risk factors and outcomes associated with post- transplant hypotension after simultaneous pancreas and kidney (SPK) Transplantation are poorly defined. SPK recipients at our center between 2010 and 2021 with functioning pancreas and kidney grafts for >6 months were included. Recipients were then divided into three groups based on active medications for the treatment of hypo-or hypertension at 6-months post-transplant: those with normal blood pressure (NBP) not requiring medication (NBP group), those on antihypertensive medications (HTN group), and those on medications for hypotension (fludrocortisone and/or midodrine) (Hypotensive group). A total of 306 recipients were included in the study: 54 (18%) in the NBP group, 215 (70%) in the HTN group, and 37 (12%) in the Hypotensive group. On multivariate analysis, the use of T-depleting induction (aHR=9.64, p=.0001, 95% Cl=3.12-29.75), pre-transplant use of hypotensive medications (aHR=4.53, p=.0003, 95% Cl=1.98-10.38), and longer duration of dialysis (aHR=1.02, p=.01, 95% Cl=1.00-1.04) were associated with an increased risk of post-transplant hypotension. Post-transplant hypotension was not associated with an increased risk of death-censored kidney or pancreatic allograft failure, or patient death. Hypotension was common even 6 months post-SPK transplantation. With appropriate management, hypotension was not associated with detrimental graft or patient outcomes.

Incidence, Risk Factors, and Outcomes of Post-Transplant Erythrocytosis Among Simultaneous Pancreas and Kidney Transplant Recipients

Incidence, Risk Factors, and Outcomes of Post-Transplant Erythrocytosis Among Simultaneous Pancreas and Kidney Transplant Recipients

Real-World Experience With CMV inSIGHT T Cell Immunity Testing in High-Risk Kidney and Pancreas Transplant Recipients.

Cytomegalovirus (CMV)-specific cell-mediated immunity is important for control of CMV after transplant. Assays exist to measure this, but their place in therapy is unclear, particularly in CMV high-risk recipients, without pretransplant exposure. The objective of this study was to evaluate predictive potential of a positive assay to determine freedom from DNAemia and describe subsequent 3-month CMV outcomes. Adult CMV high-risk kidney and/or pancreas transplant recipients were included if a CMV inSIGHT T Cell Immunity Panel (TCIP, Eurofins Viracor) was ordered and resulted between 1 August, 2019 and 30 July, 2022. Seventy-six patients were included in our study; 49 tested during prophylaxis and 27 during treatment. Most TCIP assays obtained in the prophylaxis cohort were negative (n = 46, 93.9%). Rate of post-TCIP CMV infection was 10.2%. In those tested during treatment, 33.3% were positive and rate of post-TCIP CMV recurrence was 22.2%. The positive predictive value of the assay to successfully predict immunity was 66.7% during both prophylaxis and treatment. There were 4 cases of TCIP predictive failure with progressive CMV replication. At time of replication, 2 patients had concomitant clinical confounders thought to influence immune control of viral replication. All patients had intensification of immunosuppression prior to recurrent replication, but after TCIP was collected. The data obtained from the TCIP are not static, immune control of CMV in latency can change and must be evaluated in clinical context. Timing of TCIP after transplant is significant, and patient-specific factors remain important to assess the likelihood of CMV in each unique patient-specific scenario. A CMV stewardship program can aid in application and interpretation of results.

Risk of cytomegalovirus infection and subsequent allograft failure after pancreas transplantation

Cytomegalovirus (CMV) is a common cause of infection after transplantation, but few studies have evaluated its epidemiology, risk factors, and outcomes among pancreas transplant recipients. We performed a retrospective cohort study of adults who underwent pancreas transplantation from January 1, 2010, through December 31, 2020, at 3 sites in Arizona, Florida, and Minnesota. The primary outcome was clinically significant CMV infection (csCMVi), defined as CMV disease or infection requiring antiviral therapy. The secondary outcome was pancreas allograft failure. Among 471 pancreas transplant recipients, 117 (24.8%) developed csCMVi after a median of 226 (interquartile range 154-289) days. CMV donor (D)+/R- patients had a significantly higher incidence of csCMVi (hazard ratio [HR] 4.01, 95% confidence interval [CI] 2.10-7.64; P < .001). In adjusted analysis, a lower absolute lymphocyte count (ALC) was associated with a greater risk of csCMVi among seropositive recipients (HR 1.39 per 50% decrease, 95% CI 1.13-1.73; P = .002) but not among D+/R- patients (HR 1.04 per 50% decrease, 95% CI 0.89-1.23; P = .595). csCMVi, lower ALC, and acute rejection (P < .001) were independently associated with pancreas allograft failure. In conclusion, CMV D+/R- was associated with csCMVi in pancreas recipients, although ALC was associated with csCMVi only among seropositive patients. The development of csCMVi in pancreas recipients was associated with poor pancreas allograft outcomes.

P.29: Use of basiliximab as adjunct maintenance immunosuppressant in pancreas transplant recipients

P.29: Use of basiliximab as adjunct maintenance immunosuppressant in pancreas transplant recipients

P.27: C-peptide: post-transplant trajectory in simultaneous pancreas and kidney transplant recipients

P.27: C-peptide: post-transplant trajectory in simultaneous pancreas and kidney transplant recipients

316.8: Early graft loss in solitary pancreas transplant recipients within Eurotransplant

316.8: Early graft loss in solitary pancreas transplant recipients within Eurotransplant

B-214 Serial Changes of Donor-derived Cell-free DNA in Pancreas Transplant Recipients

Abstract Background Pancreatic transplant patients need invasive pancreatic biopsies to diagnose graft rejection. Organ damage following organ donation yields circulating tissue-isolated donor-derived cell-free DNA (ddcf-DNA). Based on the ddcf-DNA ratio or quantity in several transplantations, graft rejection is predicted. Thus, we examined a 2-week ddcf-DNA monitoring study after pancreatic transplantation at this medical institution. Methods The current prospective observational study examined five pancreas transplant recipients who were sampled on postoperative days (PODs) 4, 7, 14, 30, 60, 90, 120, and 180 following the study protocol. Serum levels were determined for the following: amylase, lipase, and tacrolimus. Cell-free DNA (cf-DNA) was isolated from the plasma using a NucleoSnap cf-DNA extraction kit. The QX200 Droplet Digital PCR System was used to measure ddcf-DNA. To analyze transplant rejection and differentiate between donor and recipient, all selected single nucleotide polymorphisms (SNPs) met the following criteria: known and validated minor allele frequency of 43% in Koreans and reported ethnicities from global populations. Results The median patient age was 35 years. All recipients achieved euglycemia without exogenous insulin immediately after the surgery. All 6-month postoperative hemoglobin A1c levels were within the normal range (4%–6%). One (20%) of the five patients with pancreas transplant had a T cell-mediated rejection event on POD 531. For PODs 4, 7, 14, 30, 60, 90, and 180, the percentage (median, range) of ddcf-DNA was 2.7 (0.4–5.5), 0.6 (0.2–4.4), 3.7 (0.4–12.7), 7.1 (0.4–7.9), 2.1 (0.1–5.4), 2.0 (0.3–8.5), and 0.3 (0.2–7.6), respectively; and amylase (median, range) was 68.0 (30.0–80.0), 82.0 (57.0–151.0), 74.0 (66.0–157.0), 81.0 (50.0–137.0), 74.0 (39.0–111.0), and 80.0 (27.0–98.0). (43.0–105.0), respectively. The ddcf-DNA value of POD 14 was greater than 10% in individuals who had TCMR on POD 530. Conclusion In our study, patients with high ddcf-DNA on POD 14 after transplantation respond poorly to immunosuppressive agents, and rejection was later confirmed.

BK polyomavirus DNAemia in pancreas transplant recipients compared to pancreas-kidney recipients.

BK polyomavirus (BKV) infection is a common complication of kidney transplantation. While BKV has been described in non-kidney transplant recipients, data are limited regarding its epidemiology and outcomes in pancreas transplant recipients. We conducted a retrospective cohort study of adults who underwent pancreas transplantation from 2010-2020. The primary outcome was BKV DNAemia. Secondary outcomes were estimated glomerular filtration rate (eGFR) reduction by 30%, eGFR<30mL/min/1.73m2 , endstage kidney disease, and pancreas allograft failure. Cox regression with time-dependent variables was utilized. Four hundred and sixty-six patients were analyzed, including 74, 46, and 346 with pancreas transplant alone (PTA), pancreas-after-kidney, or simultaneous pancreas-kidney transplants, respectively. PTA recipients experienced a lower incidence of BKV DNAemia (8.8% vs. 32.9%; p<.001) and shorter duration of DNAemia (median 28.0 vs. 84.5 days). No PTA recipients with BKV DNAemia underwent kidney biopsy or developed endstage kidney disease. Lymphopenia, non-PTA transplantation, and older age were associated with BKV DNAemia, which itself was associated with pancreas allograft failure (adjusted hazard ratio 2.14, 95% confidence interval 1.27-3.60; p=.004). Among PTA recipients, BKV DNAemia was not associated with eGFR reduction or eGFR<30mL/min/1.73m2 . BKV DNAemia was common among PTA recipients, though lower than a comparable group of pancreas-kidney recipients. However, BKV DNAemia was not associated with adverse native kidney outcomes and no PTA recipients developed endstage kidney disease. Conversely, BKV DNAemia was associated with pancreas allograft failure. Further studies are needed to estimate the rate of BKV nephropathy in this population, and further evaluate long-term kidney outcomes.

Chronic gastrointestinal bleeding and anemia in a pancreas transplant recipient: A creative solution to a previously uncharacterized complication

Chronic gastrointestinal bleeding and anemia in a pancreas transplant recipient: A creative solution to a previously uncharacterized complication

Analysis of Individual Components of Frailty in Simultaneous Pancreas and Kidney, and Solitary Pancreas Transplant Recipients.

It is not known which of the 5 components of the Fried frailty score have the most predictive value for outcomes in simultaneous pancreas-kidney transplant (SPK) and solitary pancreas transplant (SPT) recipients. In this study, we sought to investigate the association between pretransplant overall frailty and individual frailty components, with posttransplant outcomes among SPK and SPT recipients. Outcomes of interest were length of stay, kidney delayed graft function (K-DGF), readmission within 30 d after discharge, cardiovascular events, acute rejection, pancreas death-censored graft failure (DCGF), kidney DCGF, and death. Of the individual frailty components among SPK (n = 113), only slow walk time was associated with an increased risk of mortality (adjusted odds ratio [aOR]: 4.99; P = 0.03). Among SPT (n = 49), higher sum frailty scores (coefficient correlation 0.29; P = 0.04) and weight loss (coefficient correlation = 0.30; P = 0.03) were associated with prolonged length of stay. Similarly, weight loss among SPT was associated with an increased risk of DCGF (aOR: 4.34; P = 0.049). Low grip strength was strongly associated with an increased risk of early readmission (aOR: 13.08; P = 0.008). We found that not all components of frailty contribute equally to predicting outcomes. Objective measurements of slow walk time, unintentional weight loss, and low grip strength were found to be associated with less optimal outcomes in pancreas transplant recipients. Targeted interventions may improve posttransplant outcomes.

Ambulatory Blood Pressure Monitoring as a Useful Tool in the Cardiological Assessment of Pancreas Transplant Recipients with Type 1 Diabetes.

Having the appropriate tools to identify pancreas recipients most susceptible to coronary artery disease (CAD) is crucial for pretransplant cardiological assessment. The aim of this study is to evaluate the association between blood pressure (BP) indices provided by ambulatory blood pressure monitoring (ABPM) and the prevalence of CAD in pancreas transplant candidates with type 1 diabetes (T1D). This prospective cross-sectional study included adult T1D patients referred for pretransplant cardiological assessment in our center. The study population included 86 participants with a median age of 40 (35-46) years. In multivariate logistic regression analyses, after adjusting for potential confounding factors, higher 24 h BP (systolic BP/diastolic BP/pulse pressure) (OR = 1.063, 95% CI 1.023-1.105, p = 0.002/OR = 1.075, 95% CI 1.003-1.153, p = 0.042/OR = 1.091, 95 CI 1.037-1.147, p = 0.001, respectively) and higher daytime BP (systolic BP/diastolic BP/pulse pressure) (OR = 1.069, 95% CI 1.027-1.113, p = 0.001/OR = 1.077, 95% CI 1.002-1.157, p = 0.043/OR = 1.11, 95% CI 1.051-1.172, p = 0.0002, respectively) were independently and significantly associated with the prevalence of CAD. Daytime pulse pressure was the strongest indicator of the prevalence of CAD among all analyzed ABPM parameters. ABPM can be used as a valuable tool to identify pancreas recipients who are most susceptible to CAD. We suggest the inclusion of ABPM in pretransplant cardiac screening in type 1 diabetes patients eligible for pancreas transplantation.

SP5.12 Pancreas Graft Outcome dictates the Renal Graft outcomes and overall patient survival in Simultaneous Kidney Pancreas (SPK) Transplant recipients. A UNOS/OPTN Transplant Registry Big Data Analysis over the last 20 years. An Epidemiology In Transplant Study Group (ETrSG) Initiative

Abstract Purpose Pancreatic graft outcomes affect the cumulative outcomes of SPK transplant, yet the impact of pancreas graft loss on renal graft and overall patient survival is yet to be reported. Methods We harmonized the UNOS/OPTN SPK Transplant data (1996-2019) reported to the U.S. Dept. of Health and Human Services to analyze survival outcomes of recipients who had all cause pancreas graft loss. The demographics report and survival analysis (renal graft/ patient survival) at 1,3, and 5 years post-transplant were data mined. Logistic Regression was done to identify predictors of survival. Results N=7036 all-cause pancreatic graft losses were reported from a cohort of N=64815 SPK Transplant recipients during the first five years of transplant. The renal graft survival was 99%, 97%, and 95% in functioning SPK transplant; 77%, 68%, and 54% in recipients with pancreatic graft loss at 1,3, and 5 years respectively. (Log-rank &amp;lt;0.001). The overall patient survival was 84%, 75%, and 66% in recipients with pancreatic graft loss at 1,3, and 5 years, respectively (Log-rank &amp;lt;0.001). Recipient age &amp;gt;45 years (p=0.008), recipient smoking history ( p&amp;lt;0.001), recipient history of hypertension ( p&amp;lt; 0.001), Recipient BMI &amp;gt;30 (p=0.01), cardiac events ( p=0.02) were the variables of importance on univariate analysis affecting renal graft and patient survival. Recipients with functioning Pancreas had a renal transplant survival benefit (0.22; 0.45) at 1 and 5 years &amp; overall patient survival (0.15; 0.33) at 1 and 5 years respectively. Conclusions Functioning pancreas graft confers survival benefit to renal graft and overall patient survival. The survival deteriorates over time since pancreas graft failure.

BI05 How do we manage organ transplant recipients after their first cutaneous squamous cell carcinoma: the UK multicentre Contemporary Outcomes After cutaneous SCC in Transplant recipients study

Abstract Cutaneous squamous cell carcinoma (cSCC) is the most common malignancy in organ transplant recipients (OTRs). Previous studies have shown that up to 75% of OTRs develop further skin cancer after their first cSCC. Interventions aimed at reducing this risk include modification of immunosuppression. However, a recent Delphi study has highlighted the lack of evidence regarding the optimal timing and nature of immunosuppression modification, and the frequency of utilization and impact of this approach at time of first cSCC is unknown. The COAST (Contemporary Outcomes After cutaneous SCC in Transplant recipients) study is a multicentre retrospective cohort study aiming to investigate contemporary management and outcomes after the first cSCC in kidney transplant recipients in the UK as a baseline for informing future interventional studies. We identified 119 consecutive kidney/kidney–pancreas transplant recipients across six centres in whom a first-ever cSCC was histologically confirmed. Median cumulative duration of immunosuppression to first cSCC was 143 months (range 5–480), median age at diagnosis was 63 years (range 44–87), 77% were male, 24% had a previous transplant, 37% had a previous skin malignancy other than cSCC and 8% had two or more cSCCs excised at the same time. Two-thirds of the first cSCCs were located on the head and neck, the median diameter was 12 mm (range 2–60) and TNM staging was T1 (64%), T2 (17%) and T3 (20%). After the first cSCC, 20% of OTRs had another cSCC within 12 months, 30% by 24 months and &amp;gt; 50% by 4 years. During the immediate follow-up (within 6 months of the first cSCC), immunosuppression was modified in 32.8% (n = 39/119) of patients (immunosuppression arm), and in 41% (n = 16/39) it was explicitly stated to be a result of cSCC diagnosis. During a median follow-up of 36 months (range 0–80; interquartile range 24–52), 21/39 (54%) in the IM arm had further cSCC(s), seven (17.9%) had metastatic cSCC, nine (23%) had graft loss, five (13%) developed further noncutaneous malignancies and 11 (28%) died during follow-up. In the nonimmunosuppression arm (n = 79), 31 (39%) had further cSCC(s), 6 (8%) had metastatic cSCC, 13 (16%) had graft loss, eight (10%) developed further noncutaneous malignancies and 18 (23%) died during follow-up. In this study, early modification of immunosuppression following a cSCC diagnosis was not associated with improved cancer-related outcomes. This may partly be explained by confounders, possible clinician selection of high-risk patients for immunosuppression modification, the 6-month window studied and the small sample size, which is the subject of ongoing analyses. Further prospective studies are urgently needed to evaluate the optimal timing and regime for immunosuppression modification for optimizing patient outcomes.