Mona Ascha1,2, Mustafa S Ascha3, Joseph Tanenbaum1, Jeremy S Bordeaux4. 1. Medical student at Case Western Reserve University School of Medicine, Cleveland, Ohio. 2. now with Department of Plastic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio. 3. Center for Clinical Investigation, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio. 4. Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio.
Abstract
Importance: Melanoma risk factors and incidence in renal transplant recipients can inform decision making for both patients and clinicians. Objective: To determine risk factors and characteristics of renal transplant recipients who develop melanoma. Design, Setting, and Participants: This cohort study of a large national data registry used a cohort of renal transplant recipients from the United States Renal Data System (USRDS) database from the years 2004 through 2012. Differences in baseline characteristics between those who did and did not develop melanoma were examined, and a survival analysis was performed. Patients with renal transplants who received a diagnosis of melanoma according to any inpatient or outpatient claim associated with a billing code for melanoma were included. A history of pretransplant melanoma, previous kidney transplantation, or transplantation after 2012 or before 2004 were exclusion criteria. The data analysis was conducted from 2015 to 2016. Exposure: Receipt of a renal transplant. Main Outcomes and Measures: Incidence and risk factors for melanoma. Results: Of 105 174 patients (64 151 [60.7%] male; mean [SD] age, 49.6 [15.3] years) who received kidney transplants between 2004 and 2012, 488 (0.4%) had a record of melanoma after transplantation. Significant risk factors for developing melanoma vs not developing melanoma included older age among recipients (mean [SD] age, 60.5 [10.2] vs 49.7 [15.3] years; P < .001) and donors (42.6 [15.0] vs 39.2 [15.1] years; P < .001), male sex (71.5% vs 60.7%; P < .001), recipient (96.1% vs 66.5%; P < .001) and donor (92.4% vs 82.9%; P < .001) white race, less than 4 HLA mismatches (44.9% vs 37.1%; P = .001), living donors (44.7% vs 33.7%; P < .001), and sirolimus (22.3% vs 13.2%; P < .001) and cyclosporine (4.9% vs 3.2%; P = .04) therapy. Risk factors significant on survival analysis included older recipient age (hazard ratio [HR] per year, 1.06; 95% CI, 1.05-1.06; P < .001), recipient male sex (HR, 1.53; 95% CI, 1.25-1.88; P < .001), recipient white race, living donors (HR, 1.35; 95% CI, 1.11-1.64; P = .002), and sirolimus (HR, 1.54; 95% CI, 1.22-1.94; P < .001) and cyclosporine (HR, 1.93; 95% CI, 1.24-2.99; P = .004) therapy. The age-standardized relative rate of melanoma in USRDS patients compared with Surveillance, Epidemiology, and End Results patients across all years was 4.9. A Kaplan-Meier estimate of the median time to melanoma among those patients who did develop melanoma was 1.45 years (95% CI, 1.31-1.70 years). Conclusions and Relevance: Renal transplant recipients had greater risk of developing melanoma than the general population. We believe that the risk factors we identified can guide clinicians in providing adequate care for patients in this vulnerable group.
Importance: Melanoma risk factors and incidence in renal transplant recipients can inform decision making for both patients and clinicians. Objective: To determine risk factors and characteristics of renal transplant recipients who develop melanoma. Design, Setting, and Participants: This cohort study of a large national data registry used a cohort of renal transplant recipients from the United States Renal Data System (USRDS) database from the years 2004 through 2012. Differences in baseline characteristics between those who did and did not develop melanoma were examined, and a survival analysis was performed. Patients with renal transplants who received a diagnosis of melanoma according to any inpatient or outpatient claim associated with a billing code for melanoma were included. A history of pretransplant melanoma, previous kidney transplantation, or transplantation after 2012 or before 2004 were exclusion criteria. The data analysis was conducted from 2015 to 2016. Exposure: Receipt of a renal transplant. Main Outcomes and Measures: Incidence and risk factors for melanoma. Results: Of 105 174 patients (64 151 [60.7%] male; mean [SD] age, 49.6 [15.3] years) who received kidney transplants between 2004 and 2012, 488 (0.4%) had a record of melanoma after transplantation. Significant risk factors for developing melanoma vs not developing melanoma included older age among recipients (mean [SD] age, 60.5 [10.2] vs 49.7 [15.3] years; P < .001) and donors (42.6 [15.0] vs 39.2 [15.1] years; P < .001), male sex (71.5% vs 60.7%; P < .001), recipient (96.1% vs 66.5%; P < .001) and donor (92.4% vs 82.9%; P < .001) white race, less than 4 HLA mismatches (44.9% vs 37.1%; P = .001), living donors (44.7% vs 33.7%; P < .001), and sirolimus (22.3% vs 13.2%; P < .001) and cyclosporine (4.9% vs 3.2%; P = .04) therapy. Risk factors significant on survival analysis included older recipient age (hazard ratio [HR] per year, 1.06; 95% CI, 1.05-1.06; P < .001), recipient male sex (HR, 1.53; 95% CI, 1.25-1.88; P < .001), recipient white race, living donors (HR, 1.35; 95% CI, 1.11-1.64; P = .002), and sirolimus (HR, 1.54; 95% CI, 1.22-1.94; P < .001) and cyclosporine (HR, 1.93; 95% CI, 1.24-2.99; P = .004) therapy. The age-standardized relative rate of melanoma in USRDS patients compared with Surveillance, Epidemiology, and End Results patients across all years was 4.9. A Kaplan-Meier estimate of the median time to melanoma among those patients who did develop melanoma was 1.45 years (95% CI, 1.31-1.70 years). Conclusions and Relevance: Renal transplant recipients had greater risk of developing melanoma than the general population. We believe that the risk factors we identified can guide clinicians in providing adequate care for patients in this vulnerable group.
Authors: Giorgia L Garrett; Paul D Blanc; John Boscardin; Amanda Abramson Lloyd; Rehana L Ahmed; Tiffany Anthony; Kristin Bibee; Andrew Breithaupt; Jennifer Cannon; Amy Chen; Joyce Y Cheng; Zelma Chiesa-Fuxench; Oscar R Colegio; Clara Curiel-Lewandrowski; Christina A Del Guzzo; Max Disse; Margaret Dowd; Robert Eilers; Arisa Elena Ortiz; Caroline Morris; Spring K Golden; Michael S Graves; John R Griffin; R Samuel Hopkins; Conway C Huang; Gordon Hyeonjin Bae; Anokhi Jambusaria; Thomas A Jennings; Shang I Brian Jiang; Pritesh S Karia; Shilpi Khetarpal; Changhyun Kim; Goran Klintmalm; Kathryn Konicke; Shlomo A Koyfman; Charlene Lam; Peter Lee; Justin J Leitenberger; Tiffany Loh; Stefan Lowenstein; Reshmi Madankumar; Jacqueline F Moreau; Rajiv I Nijhawan; Shari Ochoa; Edit B Olasz; Elaine Otchere; Clark Otley; Jeremy Oulton; Parth H Patel; Vishal Anil Patel; Arpan V Prabhu; Melissa Pugliano-Mauro; Chrysalyne D Schmults; Sarah Schram; Allen F Shih; Thuzar Shin; Seaver Soon; Teresa Soriano; Divya Srivastava; Jennifer A Stein; Kara Sternhell-Blackwell; Stan Taylor; Allison Vidimos; Peggy Wu; Nicholas Zajdel; Daniel Zelac; Sarah T Arron Journal: JAMA Dermatol Date: 2017-03-01 Impact factor: 10.282
Authors: Josep M Campistol; Valentín Cuervas-Mons; Nicolás Manito; Luis Almenar; Manuel Arias; Fernando Casafont; Domingo Del Castillo; María G Crespo-Leiro; Juan F Delgado; J Ignacio Herrero; Paloma Jara; José M Morales; Mercedes Navarro; Federico Oppenheimer; Martín Prieto; Luis A Pulpón; Antoni Rimola; Antonio Román; Daniel Serón; Piedad Ussetti Journal: Transplant Rev (Orlando) Date: 2012-08-15 Impact factor: 3.943
Authors: Pierluca Piselli; Diana Verdirosi; Claudia Cimaglia; Ghil Busnach; Lucia Fratino; Giuseppe Maria Ettorre; Paolo De Paoli; Franco Citterio; Diego Serraino Journal: Best Pract Res Clin Obstet Gynaecol Date: 2014-08-23 Impact factor: 5.237
Authors: Eric A Engels; Ruth M Pfeiffer; Joseph F Fraumeni; Bertram L Kasiske; Ajay K Israni; Jon J Snyder; Robert A Wolfe; Nathan P Goodrich; A Rana Bayakly; Christina A Clarke; Glenn Copeland; Jack L Finch; Mary Lou Fleissner; Marc T Goodman; Amy Kahn; Lori Koch; Charles F Lynch; Margaret M Madeleine; Karen Pawlish; Chandrika Rao; Melanie A Williams; David Castenson; Michael Curry; Ruth Parsons; Gregory Fant; Monica Lin Journal: JAMA Date: 2011-11-02 Impact factor: 157.335
Authors: J Adami; H Gäbel; B Lindelöf; K Ekström; B Rydh; B Glimelius; A Ekbom; H-O Adami; F Granath Journal: Br J Cancer Date: 2003-10-06 Impact factor: 7.640