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Melanoma risk and survival among organ transplant recipients
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Details:
  • Pubmed ID:
    26270022
  • Pubmed Central ID:
    PMC4640996
  • Description:
    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.

  • Document Type:
  • Collection(s):
  • Funding:
    1U58 DP000807-01/DP/NCCDPHP CDC HHS/United States
    5458DP003920/DP/NCCDPHP CDC HHS/United States
    5U58/DP003931-02/DP/NCCDPHP CDC HHS/United States
    5U58DP000824-04/DP/NCCDPHP CDC HHS/United States
    5U58DP003875-01/DP/NCCDPHP CDC HHS/United States
    5U58DP003883-03/DP/NCCDPHP CDC HHS/United States
    5U58DP003921-03/DP/NCCDPHP CDC HHS/United States
    HHSH234200537009C/PHS HHS/United States
    HHSH250201000018C/PHS HHS/United States
    HHSN261201000024C/PHS HHS/United States
    HHSN261201000034C/PHS HHS/United States
    HHSN261201000035C/PHS HHS/United States
    HHSN261201000036C/PHS HHS/United States
    HHSN261201000037C/PHS HHS/United States
    HHSN2612013000171/PHS HHS/United States
    HHSN261201300021I/PHS HHS/United States
    HSN261201000032C/PHS HHS/United States
    N01-PC-2013-00021/PC/NCI NIH HHS/United States
    N01-PC-35137/PC/NCI NIH HHS/United States
    N01-PC-35139/PC/NCI NIH HHS/United States
    N01-PC-35142/PC/NCI NIH HHS/United States
    N01-PC-35143/PC/NCI NIH HHS/United States
    T32 CA009314/CA/NCI NIH HHS/United States
    U58 DP000848-04/DP/NCCDPHP CDC HHS/United States
    U58DP000832/DP/NCCDPHP CDC HHS/United States
    U58DP003879/DP/NCCDPHP CDC HHS/United States
    U58DP12-1205 3919-03/DP/NCCDPHP CDC HHS/United States
    Z99 CA999999/Intramural NIH HHS/United States
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