Melanoma Risk and Survival among Organ Transplant Recipients

Hilary A Robbins; Christina A Clarke; Sarah T Arron; Zaria Tatalovich; Amy R Kahn; Brenda Y Hernandez; Lisa Paddock; Elizabeth L Yanik; Charles F Lynch; Bertram L Kasiske; Jon Snyder; Eric A Engels

doi:10.1038/jid.2015.312

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Melanoma Risk and Survival among Organ Transplant Recipients

Journal article

Open access

Peer reviewed

Melanoma Risk and Survival among Organ Transplant Recipients

Hilary A Robbins, Christina A Clarke, Sarah T Arron, Zaria Tatalovich, Amy R Kahn, Brenda Y Hernandez, Lisa Paddock, Elizabeth L Yanik, Charles F Lynch, Bertram L Kasiske, …

Journal of investigative dermatology, Vol.135(11), pp.2657-2665

11/2015

DOI: 10.1038/jid.2015.312

PMCID: PMC4640996

PMID: 26270022

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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.

Multivariate Analysis

Confidence Intervals

Age Factors

Humans

Middle Aged

Male

Case-Control Studies

Cause of Death

Incidence

Neoplasm Invasiveness - pathology

Skin Neoplasms - mortality

Adult

Female

Registries

Transplant Recipients - statistics & numerical data

Skin Neoplasms - pathology

Risk Assessment

Skin Neoplasms - immunology

Proportional Hazards Models

Melanoma - pathology

Disease-Free Survival

Melanoma - immunology

Organ Transplantation - adverse effects

Sex Factors

Survival Analysis

Poisson Distribution

Immunocompromised Host

Neoplasm Staging

Melanoma - mortality

Details

Title: Subtitle: Melanoma Risk and Survival among Organ Transplant Recipients
Creators: Hilary A Robbins - Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA. Electronic address: hilary.robbins@jhmi.edu
Christina A Clarke - Cancer Prevention Institute of California, Fremont, California, USA; Department of Health Research and Policy, Stanford University School of Medicine and Stanford Cancer Institute, Palo Alto, California, USA
Sarah T Arron - Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
Zaria Tatalovich - Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
Amy R Kahn - New York State Cancer Registry, Albany, New York, USA
Brenda Y Hernandez - University of Hawaii Cancer Center, University of Hawaii, Honolulu, Hawaii, USA
Lisa Paddock - New Jersey State Cancer Registry, Trenton, New Jersey, USA; Rutgers School of Public Health, Piscataway, New Jersey, USA
Elizabeth L Yanik - Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
Charles F Lynch - Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
Bertram L Kasiske - Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
Jon Snyder - Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA
Eric A Engels - Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
Resource Type: Journal article
Publication Details: Journal of investigative dermatology, Vol.135(11), pp.2657-2665
DOI: 10.1038/jid.2015.312
PMID: 26270022
PMCID: PMC4640996
NLM abbreviation: J Invest Dermatol
ISSN: 0022-202X
eISSN: 1523-1747
Publisher: United States
Grant note: 5U58DP000824-04 / NCCDPHP CDC HHS U58DP000832 / NCCDPHP CDC HHS N01PC35142 / NCI NIH HHS HHSN261201000024C / NCI NIH HHS U58 DP000807 / NCCDPHP CDC HHS HHSN2612013000171 / PHS HHS U58 DP000824 / NCCDPHP CDC HHS HHSN261201000036C / NCI NIH HHS HHSH234200537009C / PHS HHS U58DP003879 / NCCDPHP CDC HHS 5458DP003920 / NCCDPHP CDC HHS N01-PC-2013-00021 / NCI NIH HHS U58 DP003875 / NCCDPHP CDC HHS 5U58DP003921-03 / NCCDPHP CDC HHS U58 DP003931 / NCCDPHP CDC HHS U58DP12-1205 3919-03 / NCCDPHP CDC HHS N01PC35137 / NCI NIH HHS U58 DP003921 / NCCDPHP CDC HHS 5U58DP003883-03 / NCCDPHP CDC HHS U58 DP000832 / NCCDPHP CDC HHS HHSN261201000035C / NCI NIH HHS U58 DP003879 / NCCDPHP CDC HHS HSN261201000032C / PHS HHS HHSH250201000018C / PHS HHS HHSN261201300011C / CCR NIH HHS HHSN261201300071C / NCI NIH HHS N01-PC-35143 / NCI NIH HHS 5U58DP003875-01 / NCCDPHP CDC HHS 1U58 DP000807-01 / NCCDPHP CDC HHS HHSN261201300021I / PHS HHS U58 DP003920 / NCCDPHP CDC HHS U58 DP000848 / NCCDPHP CDC HHS N01-PC-35137 / NCI NIH HHS HHSN261201000034C / NCI NIH HHS N01-PC-35142 / NCI NIH HHS N01PC35139 / NCI NIH HHS P30 CA086862 / NCI NIH HHS HHSN261201300021C / NCI NIH HHS HHSN261201300011I / NCI NIH HHS HHSN261201000037C / NCI NIH HHS 5U58/DP003931-02 / NCCDPHP CDC HHS N01PC35143 / NCI NIH HHS Z99 CA999999 / Intramural NIH HHS N01-PC-35139 / NCI NIH HHS U58 DP000848-04 / NCCDPHP CDC HHS U58 DP003883 / NCCDPHP CDC HHS HHSN261201000035I / NCI NIH HHS
Language: English
Date published: 11/2015
Academic Unit: Epidemiology
Record Identifier: 9983995024002771

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