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Melanoma Risk and Survival among Organ Transplant Recipients.

Authors :
Robbins HA
Clarke CA
Arron ST
Tatalovich Z
Kahn AR
Hernandez BY
Paddock L
Yanik EL
Lynch CF
Kasiske BL
Snyder J
Engels EA
Source :
The Journal of investigative dermatology [J Invest Dermatol] 2015 Nov; Vol. 135 (11), pp. 2657-2665. Date of Electronic Publication: 2015 Aug 13.
Publication Year :
2015

Abstract

Solid organ transplant recipients, who are medically immunosuppressed to prevent graft rejection, have increased melanoma risk, but risk factors and outcomes are incompletely documented. We evaluated melanoma incidence among 139,991 non-Hispanic white transplants using linked US transplant-cancer registry data (1987-2010). We used standardized incidence ratios (SIRs) to compare incidence with the general population and incidence rate ratios (IRRs) from multivariable Poisson models to assess risk factors. Separately, we compared post-melanoma survival among transplant recipients (n=182) and non-recipients (n=131,358) using multivariable Cox models. Among transplant recipients, risk of invasive melanoma (n=519) was elevated (SIR=2.20, 95% CI 2.01-2.39), especially for regional stage tumors (SIR=4.11, 95% CI 3.27-5.09). Risk of localized tumors was stable over time after transplantation but higher with azathioprine maintenance therapy (IRR=1.35, 95% CI 1.03-1.77). Risk of regional/distant stage tumors peaked within 4 years following transplantation and increased with polyclonal antibody induction therapy (IRR=1.65, 95% CI 1.02-2.67). Melanoma-specific mortality was higher among transplant recipients than non-recipients (hazard ratio 2.98, 95% CI 2.26-3.93). Melanoma exhibits increased incidence and aggressive behavior under transplant-related immunosuppression. Some localized melanomas may result from azathioprine, which acts synergistically with UV radiation, whereas T-cell-depleting induction therapies may promote late-stage tumors. Our findings support sun safety practices and skin screening for transplant recipients.

Details

Language :
English
ISSN :
1523-1747
Volume :
135
Issue :
11
Database :
MEDLINE
Journal :
The Journal of investigative dermatology
Publication Type :
Academic Journal
Accession number :
26270022
Full Text :
https://doi.org/10.1038/jid.2015.312