{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T21:31:26Z","timestamp":1776720686188,"version":"3.51.2"},"reference-count":43,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100015027","name":"Vice Chancellor for Research and Technology, Hamadan University of Medical Sciences","doi-asserted-by":"publisher","award":["140311029895"],"award-info":[{"award-number":["140311029895"]}],"id":[{"id":"10.13039\/501100015027","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Reports"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Azathioprine (AZA) is a purine antimetabolite immunosuppressant that prevents the body from rejecting transplanted organs and is used in organ transplant recipients (OTRs). This study aimed to conduct a meta\u2010analysis to determine whether AZA usage has an increased risk of skin cancer in OTRs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>To explore the association between AZA usage and skin cancer through observational studies we conducted a systematic search across PubMed, Scopus, and Web of Science databases. A random effects model, subgroup analysis, and heterogeneity assessment were used for meta\u2010analysis. The quality of the included studies was assessed using the Newcastle Ottawa scale checklist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 27 studies with 21\u2009405 patients were included to the quantitative analysis. the overall summary estimate for non\u2010melanoma skin cancer (NMSC) risk in relation to AZA treatment according Odds ratio (OR) estimates, relative risk (RR) estimates and hazard ratio (HR) estimates were 1.83 (95% confidence interval (CI): 1.22, 2.75), 2.09 (CI: 1.41, 3.10), and 1.12 (CI: 0.93, 1.34), respectively. There was a substantial heterogeneity between studies in all types of OR estimates (I2\u2009=\u200980.75%), RR estimates (I2\u2009=\u200965.58%) and HR estimates (I2\u2009=\u200954.63%). In the subgroup analysis, there was a significant increase in squamous cell carcinoma (SCC) risk in all three estimate effects while regarding basal cell carcinoma (BCC) none of them were significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings indicate that OTRs treated with AZA are at an increased risk for SCC and NMSC. Therefore, it is recommended to prioritize monitoring for skin cancer in OTRs treated with AZA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cnr2.70473","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T02:34:00Z","timestamp":1770777240000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Azathioprine Increases the Risk of Non\u2010Melanoma Skin Cancer Among Organ Transplant Recipients; an Updated Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1724-6432","authenticated-orcid":false,"given":"Amir Mohammad","family":"Salehi","sequence":"first","affiliation":[{"name":"Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center Tehran University of Medical Sciences  Tehran Iran"},{"name":"Student Research Committee Hamadan University of Medical Sciences  Hamadan Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2491-5926","authenticated-orcid":false,"given":"Romina","family":"Rezaei","sequence":"additional","affiliation":[{"name":"Student Research Committee Hamadan University of Medical Sciences  Hamadan Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9576-1727","authenticated-orcid":false,"given":"Alireza","family":"Sadeghi","sequence":"additional","affiliation":[{"name":"Student Research Committee Hamadan University of Medical Sciences  Hamadan Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3508-9620","authenticated-orcid":false,"given":"Sanaz","family":"Omidi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Medicine Hamadan University of Medical Sciences  Hamadan Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5918-2310","authenticated-orcid":false,"given":"Salman","family":"Khazaei","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Medicine Hamadan University of Medical Sciences  Hamadan Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7465-1453","authenticated-orcid":false,"given":"Bahareh","family":"Ebrahimi","sequence":"additional","affiliation":[{"name":"Department of Dermatology, School of Medicine Hamadan University of Medical Sciences  Hamadan Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2021.03.015"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-55244-2_1"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pop.2015.07.006"},{"issue":"1","key":"e_1_2_14_5_1","article-title":"Non Melanoma Skin Cancer Pathogenesis Overview","volume":"6","author":"Didona D.","year":"2018","journal-title":"Biomedicine"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/dju382"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13863"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-4-1"},{"key":"e_1_2_14_9_1","volume-title":"The Newcastle\u2010Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta\u2010Analyses","author":"Wells G. 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