Incidence of and Risk Factors for Skin Cancer in Organ Transplant Recipients in the United States. JAMA Dermatol 2017 Mar 01;153(3):296-303
Date
01/18/2017Pubmed ID
28097368DOI
10.1001/jamadermatol.2016.4920Scopus ID
2-s2.0-85015265704 (requires institutional sign-in at Scopus site) 206 CitationsAbstract
IMPORTANCE: Skin cancer is the most common malignancy occurring after organ transplantation. Although previous research has reported an increased risk of skin cancer in solid organ transplant recipients (OTRs), no study has estimated the posttransplant population-based incidence in the United States.
OBJECTIVE: To determine the incidence and evaluate the risk factors for posttransplant skin cancer, including squamous cell carcinoma (SCC), melanoma (MM), and Merkel cell carcinoma (MCC) in a cohort of US OTRs receiving a primary organ transplant in 2003 or 2008.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter retrospective cohort study examined 10 649 adult recipients of a primary transplant performed at 26 centers across the United States in the Transplant Skin Cancer Network during 1 of 2 calendar years (either 2003 or 2008) identified through the Organ Procurement and Transplantation Network (OPTN) database. Recipients of all organs except intestine were included, and the follow-up periods were 5 and 10 years.
MAIN OUTCOMES AND MEASURES: Incident skin cancer was determined through detailed medical record review. Data on predictors were obtained from the OPTN database. The incidence rates for posttransplant skin cancer overall and for SCC, MM, and MCC were calculated per 100 000 person-years. Potential risk factors for posttransplant skin cancer were tested using multivariate Cox regression analysis to yield adjusted hazard ratios (HR).
RESULTS: Overall, 10 649 organ transplant recipients (mean [SD] age, 51 [12] years; 3873 women [36%] and 6776 men [64%]) contributed 59 923 years of follow-up. The incidence rates for posttransplant skin cancer was 1437 per 100 000 person-years. Specific subtype rates for SCC, MM, and MCC were 812, 75, and 2 per 100 000 person-years, respectively. Statistically significant risk factors for posttransplant skin cancer included pretransplant skin cancer (HR, 4.69; 95% CI, 3.26-6.73), male sex (HR, 1.56; 95% CI, 1.34-1.81), white race (HR, 9.04; 95% CI, 6.20-13.18), age at transplant 50 years or older (HR, 2.77; 95% CI, 2.20-3.48), and being transplanted in 2008 vs 2003 (HR, 1.53; 95% CI, 1.22-1.94).
CONCLUSIONS AND RELEVANCE: Posttransplant skin cancer is common, with elevated risk imparted by increased age, white race, male sex, and thoracic organ transplantation. A temporal cohort effect was present. Understanding the risk factors and trends in posttransplant skin cancer is fundamental to targeted screening and prevention in this population.
Author List
Garrett GL, Blanc PD, Boscardin J, Lloyd AA, Ahmed RL, Anthony T, Bibee K, Breithaupt A, Cannon J, Chen A, Cheng JY, Chiesa-Fuxench Z, Colegio OR, Curiel-Lewandrowski C, Del Guzzo CA, Disse M, Dowd M, Eilers R Jr, Ortiz AE, Morris C, Golden SK, Graves MS, Griffin JR, Hopkins RS, Huang CC, Bae GH, Jambusaria A, Jennings TA, Jiang SI, Karia PS, Khetarpal S, Kim C, Klintmalm G, Konicke K, Koyfman SA, Lam C, Lee P, Leitenberger JJ, Loh T, Lowenstein S, Madankumar R, Moreau JF, Nijhawan RI, Ochoa S, Olasz EB, Otchere E, Otley C, Oulton J, Patel PH, Patel VA, Prabhu AV, Pugliano-Mauro M, Schmults CD, Schram S, Shih AF, Shin T, Soon S, Soriano T, Srivastava D, Stein JA, Sternhell-Blackwell K, Taylor S, Vidimos A, Wu P, Zajdel N, Zelac D, Arron STAuthor
Edit Olasz MD, PhD Associate Professor in the Dermatology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Age Factors
Aged
Carcinoma, Merkel Cell
Carcinoma, Squamous Cell
Female
Follow-Up Studies
Humans
Incidence
Male
Melanoma
Middle Aged
Organ Transplantation
Retrospective Studies
Risk Factors
Sex Factors
Skin Neoplasms
United States
Young Adult
