Kidney transplant recipients are at greater risk of developing melanoma than the general population, according to a new study.
The study also identified risk factors for melanoma among kidney transplant patients, and these include older age, white race, use of sirolimus or cyclosporine, and receipt of a kidney from a living donor.
“We believe that the risk factors we identified can guide clinicians in providing adequate care for patients in this vulnerable group,” investigators concluded in JAMA Dermatology.
Mona Ascha, MD, of University Hospitals Cleveland Medical Center in Cleveland, and colleagues analyzed 2004–2012 renal transplant data from the US Renal Data System (USRDS). Of 105,174 recipients, 488 (0.46%) had a record of melanoma following transplantation. Among the melanoma patients, the median time to developing the cancer was 1.45 years. The age-adjusted prevalence of melanoma was 208 cases per 100,000 recipients. Melanoma was 4.9 times more likely to develop in renal transplant recipients than individuals in the general population captured in the Surveillance, Epidemiology and End Results (SEER) database, according to the investigators.
Among patients with melanoma, 349 (71.5%) were male compared with 63,802 (60.7%) individuals without melanoma. Recipients with melanoma were on average 11 years older than those without melanoma (mean 60.4 vs 49.7 years). Organ donors whose kidneys were transplanted into patients who later developed melanoma were significantly older than donors whose kidneys went to patients who did not develop melanoma (42.6 vs 39.2 years). Nearly all of the patients with melanoma (96.1%) were white. Melanoma patients were significantly more likely to have received a living donor kidney than non-melanoma patients (44.7% vs 33.7%) and to receive sirolimus (22.3% vs 13.2%) or cyclosporine (4.9% vs 3.2%). In addition, melanoma patients were significantly more likely to have fewer than 4 HLA mismatches compared with patients who did not develop melanoma (44.9% vs 37.1%).
The investigators also identified risk factors that significantly affect survival. Each 1-year increase in recipient was associated with a significant 6% increased risk of death. Male recipients had a 53% increased risk of death compared with female recipients. Recipients who received kidneys from living donors had a 35% increased risk of death compared with recipients of deceased-donor kidneys. Dr Ascha’s team noted that the higher death risk observed among recipients of living donor kidneys is at odds with previous studies showing that recipients of solid organ transplants (SOTs) from deceased donors have a greater incidence of cancer and death. “It is believed that greater doses of immunosuppressive agents in patients with SOTs from deceased donors result in greater cancer susceptibility,” they wrote. “However, it is possible that patients with SOTs from living donors achieve a greater life expectancy, and older age increases melanoma risk.”
Additionally, results showed that sirolimus recipients had a significant 54% increased risk of death compared with non-recipients and cyclosporine-treated patients had a significant 93% increased risk of death compared with those who did not receive the drug.
Ascha M, Ascha MS, Tanenbaum J, Bordeaux JS. Risk factors for melanoma in renal transplant recipients. JAMA Dermatol 2017; published online ahead of print. doi: 10.1001/jamadermatol.2017.2291