- Design
- Retrospective single-centre cohort, 2010–2023
- Population
- 395 solid organ transplant recipients in Sweden
- Primary outcome
- Time to first invasive skin cancer after transplant
- Effect
- High vs low risk HR 11.90 (95% CI 7.02 to 20.19); intermediate vs low HR 5.98 (4.05 to 8.34)
Karolinska University Hospital grades solid organ transplant recipients as low, intermediate or high risk for skin cancer and schedules follow-up accordingly. This retrospective cohort followed 395 recipients from 2010 to 2023 to test that model.
Over a third (38%) developed invasive skin cancer. Against low-risk recipients, the adjusted hazard of invasive skin cancer was 5.98 (95% CI 4.05 to 8.34) for intermediate risk and 11.90 (7.02 to 20.19) for high risk. All-cause mortality was also higher (HR 1.53 and 1.97). Ten developed metastases and four died of skin cancer.
The model discriminated well, which supports spending specialist visits on the recipients most likely to need them rather than seeing everyone at the same interval. It has not been compared with any other schedule, so it shows who is at risk, not that grading improves outcomes.
- Grade every new transplant recipient's skin cancer risk at the first visit.
- Record prior skin cancer, skin type, sun exposure and immunosuppressive regimen.
- See high-risk recipients most often; do not discharge low-risk recipients entirely.
- Teach monthly self-examination and sun protection at the first visit.
- Tell the transplant team when a recipient develops multiple SCCs — immunosuppression may need review.
Why it matters
Surveillance time is limited, and this shows a simple grade can tell you where to spend it.
Don't overread it
It shows the grade predicts risk; it does not show that risk-based follow-up saves lives compared with other schedules.
The statistics, in plain English
A hazard ratio of 11.90 means high-risk recipients developed invasive skin cancer at about twelve times the rate of low-risk ones over time. The wide interval (7 to 20) reflects only 30 people in the high-risk group. Higher mortality in these groups probably reflects overall health as much as skin cancer.
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