固体器官移植受者（SOTR）患有更高的皮肤癌风险，且患病特定的发病率和死亡率更高。为了为不断扩大的SOTR人群分层风险并针对性地筛查皮肤癌，需要详细了解风险因素。本研究使用结合临床和病理数据来捕获太阳性角化症（AK）和皮肤癌的患病率，旨在确定丹麦SOTR队列的皮肤癌发展风险因素。该试验包括回顾性队列研究，对2009-2021年丹麦哥本哈根市Bispebjerg和Gentofte医院皮肤科的器官移植门诊患者进行研究。除了病理记录外，通过审查SOTR就诊的电子病历（EMR），特别是包括临床AK描述的病历，确定了AK患病率。皮肤癌患病率的定义为基底细胞癌（BCC）、鳞状细胞癌（SCC）（侵袭性或原位）或黑色素瘤（侵袭性或原位），通过EMR和病理编码审查确定。从EMR中提取的其他数据包括年龄、性别、菲茨帕特里克皮肤类型和移植日期、类型和免疫抑制治疗。风险因素对皮肤癌的影响通过Cox比例风险回归计算。总共包括822名SOTR，平均随访时间为10.8年（SD 2.4年）。人群中发现30％（n=250）皮肤畸形诊断，包括AK（22％，n=177）、皮肤癌（23％，n=186）或两者（14％，n=113）。AK诊断预测SCC（OR：31.5（95％CI 9.8-100.6），p<0.0001）和BCC（OR：2.3（95％CI 1.6-3.3），p<0.0001）的发展，诊断AK的时间平均比首次SCC发病前提前3.1年（p<0.0001）。相应地，虽然没有AK的SOTR移植后25年的SCC风险为1.4％，但有AK的SOTR移植后仅10年就有23％的SCC风险。其他已确定的风险因素还包括菲茨帕特里克I型皮肤（BCC：OR：2.4（95％CI 1.2-5.0），p=0.018；SCC：3.2（95％CI 1.2-8.2），p=0.016）和移植时间>15年（BCC：OR 1.8（95％CI 1.2-2.7），p=0.007）。未显示皮肤癌发展与性别或免疫抑制方案之间的显着关联。在SOTRS中，角质细胞癌与AK诊断密切相关，应提示患者加强皮肤癌筛查。S. Karger AG，巴塞尔。

Solid organ transplant recipients (SOTRs) are at increased risk of skin cancer and suffer from greater disease-specific morbidity and mortality. To risk stratify the expanding SOTR population for more targeted skin cancer screening, a detailed understanding of risk factors is needed. Using combined clinical and pathological data to capture prevalence of actinic keratosis (AK) and skin cancer, this study aimed to identify risk factors of skin cancer development in a Danish SOTR cohort.The trial comprised a retrospective cohort study of patients attending organ transplant clinics at the dermatological departments of Bispebjerg and Gentofte Hospitals in Copenhagen, Denmark between 2009-2021. In addition to pathology records, AK prevalence was determined by review of electronic medical records (EMR) of SOTR visits which specifically included descriptions of clinical AK. Prevalence of skin cancer, here defined as basal cell carcinoma (BCC), squamous cell carcinoma (SCC) (invasive or in situ), or melanoma (invasive or in situ), was determined by EMR and pathology code review. Additional data extracted from EMRs included age, sex, Fitzpatrick skin type, and transplantation date, -type and immunosuppressive therapy. The effect of risk factors on skin cancer was calculated by Cox proportional hazards regression.A total of 822 SOTRs were included with a mean follow-up duration of 10.8 years (SD 2.4 years). A skin dysplasia diagnosis was identified in 30% (n=250) of the population, consisting of either AK (22%; n=177), skin cancer (23% n=186), or both (14%; n=113). An AK diagnosis predicted both SCC (OR: 31.5 (95% CI 9.8-100.6), p<0.0001) and BCC development (OR: 2.3 (95% CI 1.6-3.3), p<0.0001), with AKs diagnosed an average 3.1 years before the first SCC (p<0.0001). Correspondingly while the risk of SCC in SOTRs without AK was 1.4% 25 years after transplantation, SOTRs with AKs had a 23% SCC risk only 10 years post-transplant. Other identified risk factors included Fitzpatrick skin type I (BCC: OR: 2.4 (95% CI 1.2-5.0), p=0.018; SCC: 3.2 (95% CI 1.2-8.2), p=0.016) and transplantation duration >15 years (BCC: OR 1.8 (95% CI 1.2 - 2.7), p=0.007). No significant association between skin cancer development and sex or immunosuppressive regimen was shown.Keratinocyte carcinoma is strongly associated with an AK diagnosis in SOTRS and should prompt intensified skin cancer screening in affected individuals.S. Karger AG, Basel.