Immunosuppressive Choices Shape Skin Cancer Risk in Transplant Patients

Background: Solid organ transplant recipients (SOTRs) have a markedly increased risk of skin cancer due to chronic immunosuppression, particularly with calcineurin inhibitors (CNIs), such as tacrolimus and cyclosporin. Mammalian target of rapamycin inhibitors (mTORis), such as everolimus and sirolimus, have been suggested to reduce skin cancer risk, but real-world data, especially for regimens combining mTORis with CNIs, remain limited. Objective: To evaluate how current immunosuppressive strategies impact skin cancer risk. Design/Participants: Prospective cohort study conducted at a single tertiary center in Barcelona, Spain, which included 1055 adult solid organ transplant recipients from 2011 to 2021. Methods: Time-varying immunosuppressive regimens were assessed, including CNIs (primarily tacrolimus), mTORis (everolimus and sirolimus), antimetabolites, and corticosteroids. The primary outcome was the incidence of skin cancer (squamous cell carcinoma [SCC], basal cell carcinoma [B more...