{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T23:42:05Z","timestamp":1788392525367,"version":"build-2803163510"},"reference-count":55,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Solid organ transplant recipients (SOTRs) are at increased risk of developing skin cancer due to long-term immunosuppressive (IS) therapy. Calcineurin inhibitors (CNIs), particularly tacrolimus and ciclosporin, are associated with elevated skin cancer risk. Mammalian \u00adtarget of rapamycin inhibitors (mTORis) are considered protective, but real-life evidence of their effectiveness, especially when combined with reduced-dose CNIs, is limited. Understanding the impact of current IS regimens on skin cancer risk is essential for improving patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the relative risk of different IS drugs and regimens on skin cancer development in SOTRs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective observational study at Vall d\u2019Hebron University Hospital, Barcelona, Spain, from 2011 to 2021. The study included 1055 SOTRs from a mixed-organ cohort, with a combined follow-up of 3336 person-years. Real-life IS drug regimens were recorded during scheduled posttransplant screenings or dermatological follow-ups. Cox proportional hazards models with shared frailty were used to assess skin cancer risk, accounting for multiple events and adjusting for time-varying drug exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Skin cancer occurred in 131 of 1055 SOTRs (12.4%). A total of 450 skin cancer events were registered, including 317 squamous cell carcinomas (70%), 118 basal cell carcinomas (26%) and 15 melanomas (3%). mTORi-based regimens were associated with significantly lower skin cancer rates [hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.47\u20130.92; P = 0.01]. Everolimus appeared more protective than sirolimus (HR 0.38, 95% CI 0.21\u20130.69; P &amp;lt; 0.001). Reduced-dose CNIs combined with mTORis were linked to a 37% reduction in skin cancer rates in high-risk patients (HR 0.63, 95% CI 0.42\u20130.93; P = 0.02) and a 32% reduction in patients with posttransplant events (HR 0.68, 95% CI 0.47\u20130.98; P = 0.04). The reduction was mainly driven by decreased squamous cell carcinoma incidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>mTORi-based regimens, particularly with reduced-dose tacrolimus, appear to offer a safer and more effective alternative to CNI-heavy regimens for skin cancer prevention in SOTRs. Real-life data support the integration of mTORis into IS strategies to reduce skin cancer risk, particularly for high-risk patients and those who developed skin malignancies.<\/jats:p>\n                    <jats:p>An author video to accompany this article is available online.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjd\/ljaf483","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T13:07:05Z","timestamp":1764162425000},"page":"747-757","source":"Crossref","is-referenced-by-count":6,"title":["Immunosuppressive regimens and skin cancer risk in solid-organ transplant recipients"],"prefix":"10.1093","volume":"194","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9388-5623","authenticated-orcid":false,"given":"\u00c1lvaro","family":"G\u00f3mez-Tom\u00e1s","sequence":"first","affiliation":[{"name":"Department of Dermatology, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]},{"name":"School of Medicine, Universitat Aut\u00f2noma de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Gonz\u00e1lez-Cruz","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]},{"name":"School of Medicine, Universitat Aut\u00f2noma de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"Garc\u00eda-Patos","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]},{"name":"School of Medicine, Universitat Aut\u00f2noma de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Ferr\u00e1ndiz-Pulido","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hospital Universitari Vall d\u2019Hebron , 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