Background: Organ transplant recipients (OTR) develop skin cancers at high rates. Although these patients often develop multiple skin cancers, few studies account for the total number developed. Due to skin cancer’s morbidity and mortality in the transplant population, it is critical to identify high-risk patients prior to developing multiple skin cancers. Methods: We examined differences in rates of skin cancer development in a validated cohort of OTR at a single tertiary-care hospital. We used data from the electronic health record both to identify patients and to count skin cancers. We compared rates of skin cancer development based on organ type, age at transplant, and other factors using log-rank tests and Kaplan-Meier plots. Results: There were 5,190 OTR included. Seven hundred patients had at least one skin cancer, and there were 6,864 skin cancers overall. Seventy patients contributed a total of 3,319 skin cancers, which was 48.4% of all skin cancers. Lung transplant recipients had the highest proportion of skin cancer cases (69/398, 17.3%), but the lowest mean number of skin cancers per patient (4.6 ± 4.8). Compared to liver transplant recipients, heart, lung, or kidney recipients were more likely to develop at least one skin cancer (p < 0.0001). There was no difference by transplant type in the rate of developing a second (p = 0.07) or third skin cancer (p = 0.50); the rates remained unchanged when stratified by age group at transplant (p < 0.0001). There was an increased rate of developing a first skin cancer with increasing age at transplant. Conclusions: Organ transplant recipients have different risks for first skin cancer development based on transplanted organ type and age at transplantation. Age at transplant remained strongly associated with the risk of subsequent skin cancers; however, transplanted organ type did not impact subsequent skin cancer risk.
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