Renal allograft recipients (RARs) have a well-documented increased incidence of viral
warts and cutaneous
neoplasia, particularly those with long graft life and high sun exposure. A clinicopathological survey of 69 RARs in south-east Scotland, with follow-up periods of up to 28 years after
transplantation, revealed marked variation in patient susceptibility to cutaneous
malignancy with concomitant variation in HPV prevalence.
Skin cancers were found in 34 patients. Eight patients showed high susceptibility [defined as more than four intraepidermal
carcinomas (IECs) or invasive
squamous cell carcinomas (SCCs)] 42 had intermediate susceptibility (1-3 IECs or SCCs, or >3
keratoses) and 18 had low susceptibility (< or = 3
keratoses and no
cancers). SCCs, IECs and
keratoses from the high-susceptibility group were found to have greater prevalences of human papillomavirus (HPV)
DNA (56%, 45% and 50% respectively), than SCCs (0%) and IECs (33%) from intermediate-susceptibility RARs and
keratoses (36%) from the combined intermediate- and low-susceptibility groups and compared with a group of immunocompetent controls (27%, 20% and 15% respectively). No differences in p53
protein accumulation, determined immunohistochemically, were observed in tumours from the three groups. Categorization of RARs by susceptibility to cutaneous
malignancy provides clinically useful information, as significantly more high-susceptibility patients (38%) developed aggressive, potentially lethal anogenital or cutaneous
squamous cell cancers than did patients in the intermediate group (5%, P=0.005) or the low-susceptibility group (0%).