Impact of immunosuppressive therapy on non-melanoma skin cancer after solid organ transplantation: A critical systematic review.

Recent advancements in immunosuppressive therapy have markedly reduced graft rejection rates post-transplantation and improved the life expectancy of solid organ transplant recipients. However, these improved long-term outcomes are accompanied by an increased risk of complications, of which skin malignancies remain significantly challenging. Unlike prior reviews that analyzed solid organ transplant recipients as a pooled population, we focused on examining the association between immunosuppressive therapy and the potential risk of non-melanoma skin cancer (NMSC) within organ-specific cohorts. This review provides a distinct perspective by emphasizing the role of induction and maintenance immunosuppressive therapy in the development of NMSC in individual transplant settings, particularly kidney, liver, lung, and heart transplantation, with brief reference to pancreas transplantation. Across organs, basiliximab was generally associated with a lower reported incidence of NMSC than T-cell depleting agents, although the strength and consistency of this association varied among organ types. In addition, calcineurin inhibitors were consistently associated with a higher incidence of NMSC across multiple organ-specific cohorts, whereas sirolimus and mycophenolate-based regimens were associated with a lower reported incidence in some cohorts. However, current data do not support routine modification of immunosuppression regimens solely for transplant recipients with NMSC. Greater emphasis should instead be placed on preventive strategies, including regular structured skin examinations and a dedicated post-transplant dermatology clinics for high-risk populations.