Melanoma Risk and Survival among Organ Transplant Recipients.
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.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA. Electronic address: hilary.robbins@jhmi.edu.
Hilary A
HA
Robbins
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.
Christina A
CA
Clarke
Department of Dermatology, University of California, San Francisco, San Francisco, California, USA.
Sarah T
ST
Arron
Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA.
Zaria
Z
Tatalovich
New York State Cancer Registry, Albany, New York, USA.
Amy R
AR
Kahn
University of Hawaii Cancer Center, University of Hawaii, Honolulu, Hawaii, USA.
Brenda Y
BY
Hernandez
New Jersey State Cancer Registry, Trenton, New Jersey, USA; Rutgers School of Public Health, Piscataway, New Jersey, USA.
Lisa
L
Paddock
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA.
Elizabeth L
EL
Yanik
Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA.
Charles F
CF
Lynch
Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota, USA.
Bertram L
BL
Kasiske
Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA.
Jon
J
Snyder
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA.
Eric A
EA
Engels
D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D002423:Cause of Death; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000276:immunology* / Q000401:mortality* / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D016377:Organ Transplantation / Q000009:adverse effects; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012737:Sex Factors; D012878:Skin Neoplasms / Q000276:immunology* / Q000401:mortality* / Q000473:pathology; D016019:Survival Analysis; D066027:Transplant Recipients / Q000706:statistics & numerical data