Organ Transplant Recipients Can Have Significantly Increased Risk of OSSN

It appears that recipients of solid organ transplants are particularly vulnerable to developing cancers and OSSN due to either a greater degree of immunosuppression or to mechanisms as yet not understood. Photo: Chris Sindt, OD. Click image to enlarge. Recipients of solid organ transplants are at heightened risk of skin cancer, which is considered an adverse consequence of the long-term immunosuppressive therapy required to avoid tissue rejection. It is generally assumed that patients with organ transplants are also at greater risk of ocular surface neoplasia (OSSN), because the conjunctiva and skin share several key risk factors for surface neoplasia.Researchers at the University of South Florida in Tampa used the TriNetX research platform to explore the association between solid organ transplant recipients maintained on immunosuppressive drugs and the development of OSSN. Those on immunosuppressive therapy had a 2.3 times higher risk of developing OSSN during the study period, they found. However, this increased risk of OSSN was far less pronounced than the 65- to 100-fold increased risk of squamous cell carcinomas estimated by previous studies.The retrospective study, which was published in American Journal of Ophthalmology, included individuals ≥18 years of age receiving oral or intravenous tacrolimus, cyclosporine, sirolimus, mycophenolate, everolimus or azathioprine. The control cohort included individuals with multiple ophthalmology follow-ups, no prior OSSN diagnoses and no exposure to the medications of interest. After matching, 43,580 individuals were included for analysis. There were 46 (0.11%) new cases of OSSN in the exposure cohort and 20 (0.05%) cases in the control cohort.Sensitivity analyses requiring additional instances of medication exposure (odds ratio; OR: 3.67) or controlling for other indications of immunosuppressive therapy (OR: 1.70) showed consistent results. Excluding all recipients of solid organ transplant resulted in no significant association with OSSN (OR: 1.31).“Although we conducted several subanalyses to better isolate the effects of solid organ transplant and immunosuppression on OSSN risk, we were unable to perform a direct, propensity-matched analysis solely with recipients of solid organ transplant,” the study authors wrote in their paper.The study team did note that TriNetX lacks granular, patient-level ophthalmological data, rendering them unable to assess important histopathological characteristics of the neoplasms like size, location and depth of invasion.“As these recipients continue to live longer, the prevalence of transplant-associated malignancies is likely to increase. It is therefore essential that eyecare practitioners appropriately monitor these individuals,” they concluded. “Tumors in these individuals with persistent deficient T-cell function are probably more aggressive and could carry a higher recurrence rate after excision. Prospective clinical studies will be needed to better elucidate this relationship and provide refined clinical guidance.”Click here for the journal source. Lin F, Margo CE, Espana EM. Increased risk for ocular surface neoplasia in recipients of solid organ transplant. Am J Ophthalmol. June 28, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.