A new hypothesis to explain skin cancer risk in kidney allograft recipients

Kidney transplant (KT) recipients have an increased risk for specific types of cancer. Some forms of incident cancer are similarly present in other diseases where T-cells are depleted, such as HIV-infection: specifically, non-Hodgkin lymphoma and Kaposi’s sarcoma. Conversely, other forms of highly incident cancers in KT patients, primarily non-melanoma skin cancer (squamous cell carcinoma and basal cell carcinoma), are specific to this condition. By comparing HIV-related cancers, general cancer incidence, and the association of immunotherapy with cancer incidence, we suggest that the high incidence of non-melanoma skin cancer seen in KT patients is mediated by off-target effects of calcineurin inhibitors in the skin, combined with a “permissive” cancer microinflammatory environment.