- Design
- Population-based cohort linking transplant and death registries, 1990 to 2019
- Population
- 21,503 first kidney transplant recipients in Australia and New Zealand
- Primary outcome
- Skin cancer mortality and standardised mortality ratio against the general population
- Effect
- 118.2 deaths per 100,000 person-years; SMR 11.1 overall, 34.5 keratinocyte cancer, 4.5 melanoma
Australian and New Zealand registry data on 21,503 people who received a first kidney transplant between 1990 and 2019 were linked to national death registers. There were 251 skin cancer deaths over 212,317 person-years: 82 from melanoma and 169 from keratinocyte cancer.
The absolute rate was 118.2 per 100,000 person-years. Compared with the general population, mortality was 11.1 times higher overall, 4.5 times for melanoma and 34.5 times for keratinocyte cancer. The excess appeared in both sexes, all age groups and all decades, and was greatest in high-UV regions such as Queensland (SMR 14.8, 95% CI 11.7 to 18.8).
The data are Australasian and the ultraviolet exposure differs from many other settings, so absolute rates should not be transferred directly to India. The pattern, a sharply raised risk of death from keratinocyte cancer, still argues for regular skin checks and quick treatment in anyone on long-term immunosuppression.
- Include a full skin examination in the routine follow-up of every transplant recipient.
- Treat suspicious keratinocyte lesions early and refer promptly rather than watching them.
- Reinforce daily sun protection, particularly for people living in high-UV areas.
- Ask about the cumulative duration and intensity of immunosuppression when setting review intervals.
- Do not apply the Australian absolute rates to local patients; use them to convey direction of risk.
Why it matters
Skin cancer in transplant recipients is a cause of death, not only of disfigurement, and the mortality gap has not narrowed over three decades.
Don't overread it
Registry-based and descriptive; it shows who is at risk, not whether any surveillance schedule reduces deaths.
The statistics, in plain English
A standardised mortality ratio of 11.1 means about eleven deaths for every one expected at general-population rates of the same age and sex. The ratios compare against national statistics rather than a matched control group, so differences in other health factors are not accounted for.
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