Increased Risk of Postoperative Complications in Organ Transplant Recipients Undergoing Mohs Micrographic Surgery

Abstract

Background: Solid organ transplant recipients (SOTRs) are at increased risk of developing nonmelanoma skin cancers (NMSC), which may require treatment by Mohs micrographic surgery (MMS). Previous small-scale studies yielded conflicting findings on post-MMS complications in immunosuppressed individuals, and large-scale population-based analyses for SOTRs undergoing MMS are lacking.

Objective: The authors investigate postoperative complications after MMS in SOTRs using the TriNetX database of over 106 million patients in the US Collaborative Network.

Materials and methods: Among MMS recipients in this database, a cohort of organ transplant recipients and a cohort of immunocompetent patients were generated. Immunosuppressive medications other than antirejection medications for the SOTR cohort were excluded from both groups. The outcomes for common postoperative complications including infection, wound disruption, graft failure, bleeding, rash, disturbance of skin sensation, and hypertrophic scarring were assessed during a 60-day postoperative window.

Results: SOTRs exhibit a twofold increased risk of postoperative infection, 2.5-fold increased risk of surgical wound disruption, and over threefold increased likelihood of swelling within 60 days post-MMS compared with immunocompetent patients. There was no significant difference in bleeding between the cohorts.

Conclusion: Given these findings, it may be worth assessing the role of antibiotics and close monitoring for the SOTR population in larger prospective studies to inform future surgical guidelines.