BI16 The COAST (Contemporary Outcomes After cutaneous SCC in Transplant recipients) study: final results and implications for management following the first cutaneous squamous cell carcinoma in kidney transplant recipients

Cutaneous squamous cell carcinoma (cSCC) is the most common post-transplant malignancy. Historical studies indicate that up to 25% of organ transplant recipients will develop a new cSCC within 12 months of their first cSCC, with doubled metastatic risk compared with immunocompetent cohorts. However, evidence is limited regarding optimal secondary prevention strategies used by transplant and dermatology practitioners. To address this, we undertook a multicentre retrospective cohort study to evaluate contemporary management and outcomes after a first cSCC in kidney transplant recipients (KTRs). We present the final results from the COAST study, including a proposed risk stratification approach to management after a first cSCC based on clinicopathological predictors for poor outcomes. Adult KTR with a first-ever cSCC between 2016 and 2020 were included from eight UK centres. Follow-up was to December 2022. Outcomes of interest included new cSCC and a composite ‘poor outcome’, which included new malignancy, cSCC metastasis, graft loss and death from any cause. In 136 KTRs, the cumulative duration of immunosuppression at first cSCC was 136 months (interquartile range 68–204) and the median age 64 years (interquartile range 57–72). The first cSCC was high-risk in 24% by the 8th edition of the American Joint Committee on Cancer staging system, 11% by the Brigham and Women’s Hospital criteria, and 30% by the British Association of Dermatologists’ 2020 guidelines criteria. Nine (7%) had multiple cSCCs (range two to three) excised at the first episode. The median duration of follow-up after the first cSCC was 39 months. Within 6 months of the first cSCC, 21% of KTRs were using topical chemoprevention (mainly 5-fluorouracil cream), 6% started systemic chemoprevention (acitretin or nicotinamide) and 5% used destructive therapies. Immunosuppression reduction (IR) was undertaken in 30%, and this was explicitly due to CSCC in 56%. Immunosuppression reduction strategies varied both within and between centres and were more frequently undertaken in patients with high-risk CSCC or in those on azathioprine (P = 0.01). Further cSCC was diagnosed in 49% (at a median 13 months), 13% had metastatic cSCC (median 11 months), 13% had graft loss (median 34 months) and 29% died (median 22 months). Malignancy was the leading cause of death, with cSCC-specific death in 28%. Survival modelling revealed clinicopathological predictors for poor outcomes, including high-risk CSCC, multiple first cSCCs and a history of BCC. These findings were compared with a US KTR cohort with a first-ever cSCC, showing similarly poor outcomes in this group. While the incidence of primary post-transplant cSCC may be declining in KTR cohorts, our data suggest that outcomes after a first cSCC remain unimproved compared with historical cohorts. These data highlight the urgent need for prospective studies to identify optimal management of KTR following a first cSCC. Here we propose a risk stratification approach that may be used to guide prevention strategies.

Citation

Peleva, E., Crisp, T., Cernova, J., Nawab, K., Gauci, M. A., Gamble, J., ... & Bottomley, M. (2025). BI16 The COAST (Contemporary Outcomes After cutaneous SCC in Transplant recipients) study: final results and implications for management following the first cutaneous squamous cell carcinoma in kidney transplant recipients. British Journal of Dermatology, 193(Supplement_1), ljaf085-425.

DOI

10.1093/bjd/ljaf085.425

URI

https://hdl.handle.net/20.500.14709/1155

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