Risk of merkel cell carcinoma after solid organ transplantation

Christina A Clarke; Hilary A Robbins; Zaria Tatalovich; Charles F Lynch; Karen S Pawlish; Jack L Finch; Brenda Y Hernandez; Joseph F Fraumeni Jr; Margaret M Madeleine; Eric A Engels

doi:10.1093/jnci/dju382

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Risk of merkel cell carcinoma after solid organ transplantation

Journal article

Open access

Peer reviewed

Risk of merkel cell carcinoma after solid organ transplantation

Christina A Clarke, Hilary A Robbins, Zaria Tatalovich, Charles F Lynch, Karen S Pawlish, Jack L Finch, Brenda Y Hernandez, Joseph F Fraumeni Jr, Margaret M Madeleine and Eric A Engels

JNCI : Journal of the National Cancer Institute, Vol.107(2), pp.dju382-dju382

02/2015

DOI: 10.1093/jnci/dju382

PMCID: PMC4311175

PMID: 25575645

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Abstract

Solid organ transplant recipients have elevated risks of virus-related cancers, in part because of long-term immunosuppression. Merkel cell carcinoma (MCC) is an aggressive skin cancer recently found to have a viral origin, but little is known regarding the occurrence of MCC after transplant. We linked the US Scientific Registry of Transplant Recipients with data from 15 population-based cancer registries to ascertain MCC occurrence among 189498 solid organ transplant recipients from 1987 to 2009. Risks for MCC following transplantation were compared with the general population using standardized incidence ratios, and Poisson regression was used to compare incidence rates according to key patient and transplant characteristics. All statistical tests were two-sided. After solid organ transplantation, overall risk of MCC was increased 23.8-fold (95% confidence interval = 19.6 to 28.7, n = 110). Adjusted risks were highest among older recipients, increased with time since transplantation, and varied by organ type (all P ≤ .007). Azathioprine, cyclosporine, and mTOR inhibitors given for maintenance immunosuppression increased risk, and non-Hispanic white recipients on cyclosporine and azathioprine experienced increasing MCC risk with lower latitude of residence (ie, higher ultraviolet radiation exposure, P = .012). MCC risk is sharply elevated after solid organ transplant, likely resulting from long-term immunosuppression. Immunosuppressive medications may act synergistically with ultraviolet radiation to increase risk.

Organ Transplantation

Registries

United States - epidemiology

Humans

Middle Aged

Male

Photosensitizing Agents - adverse effects

Carcinoma, Merkel Cell - etiology

Transplant Recipients

Incidence

Photosensitizing Agents - administration & dosage

TOR Serine-Threonine Kinases - antagonists & inhibitors

Adult

Female

Remission Induction - methods

Carcinoma, Merkel Cell - epidemiology

Immunosuppressive Agents - administration & dosage

Risk Assessment

Risk Factors

Skin Neoplasms - epidemiology

Ultraviolet Rays - adverse effects

Cyclosporine - adverse effects

Immunosuppressive Agents - adverse effects

Poisson Distribution

Aged

Skin Neoplasms - etiology

Immunocompromised Host

Azathioprine - adverse effects

Details

Title: Subtitle: Risk of merkel cell carcinoma after solid organ transplantation
Creators: Christina A Clarke - Cancer Prevention Institute of California
Hilary A Robbins - National Institutes of Health
Zaria Tatalovich - National Institutes of Health
Charles F Lynch - University of Iowa, Epidemiology
Karen S Pawlish - New Jersey Department of Health
Jack L Finch - Colorado Department of Public Health and Environment
Brenda Y Hernandez - University of Hawaii System
Joseph F Fraumeni Jr - National Institutes of Health
Margaret M Madeleine - University of Washington
Eric A Engels - University of Washington
Resource Type: Journal article
Publication Details: JNCI : Journal of the National Cancer Institute, Vol.107(2), pp.dju382-dju382
DOI: 10.1093/jnci/dju382
PMID: 25575645
PMCID: PMC4311175
NLM abbreviation: J Natl Cancer Inst
ISSN: 1460-2105
eISSN: 1460-2105
Publisher: Oxford University Press; United States
Grant note: P30 ES005605 / NIEHS NIH HHS P50 CA174521 / NCI NIH HHS
Language: English
Date published: 02/2015
Academic Unit: Epidemiology
Record Identifier: 9983995121002771

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