The underestimated skin cancer risk after liver transplantation: a systematic review and meta-analysis.

Introduction: The aim of this this systematic review and meta-analysis was to assess the prevalence of skin cancer in post-liver transplant recipients (LTRs).

Evidence acquisition: Five databases were systematically searched until 20^th April 2023. Search terms included ("liver transplantation" OR "liver transplant") AND ("skin cancer" OR "melanoma" OR "squamous cell carcinoma" OR "non-melanoma skin cancer" OR "post-transplant cancer" OR "post transplant cancer"). Random effect model were used to overcome the significant heterogeneity observed.

Evidence synthesis: A total of 34 studies were included. The overall skin cancer prevalence in LTRs was 4.6% (95% CI: 3.4-6.1). Subgroup analysis based upon the follow-up duration of each study indicated that skin cancer prevalence increased with longer follow-up durations: 0-4 years, 0.8% (95% CI: 0.4-1.9), 4-8 years, 4.3% (95% CI: 3.1-5.8), and 8-12 years, 5.3% (95% CI: 1.9-14). Furthermore, subgroup analysis based upon continental distribution of skin cancer indicated that Australia 21% (95% CI: 13-31) followed by South America 9.4% (95% CI: 5.8-15) had the highest prevalence of skin cancer. SCC was the most common type of skin cancer with a prevalence of 2.6% (95% CI: 1.5-4.5), subsequently followed by BCC 2.5% (95% CI: 1.5-4.2).

Conclusions: Skin cancer following liver transplantation is not a rare condition. Substantial dermatological surveillance programs are recommended in post-liver transplant recipients to improve the quality of life as well as the associated mortality; especially with the increased prevalence after long follow-up durations.