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Pretransplant melanoma associated with melanoma, mortality after transplant

Researchers found an association between pretransplant melanoma and increased melanoma-specific mortality, overall mortality and incident melanoma after transplant, according to recently published study results.

Sarah T. Arron, MD, PhD, of the department of dermatology at the University of California, San Francisco, and colleagues used the Transplant Cancer Match (TCM) study to measure outcomes of 185,039 transplant recipients (62% male; mean age at transplant, 49 years). The impact of transplantation also was analyzed on 141,441 patients with melanoma unidentified in six cancer registries in the TCM.

Sarah T. Arron

Among transplant recipients, 336 (0.18%) had pretransplant melanoma. In a comparison with patients without pretransplant melanoma, these patients also had a significantly increased risk for melanoma-specific mortality (adjusted HR = 27; 95% CI, 11-64), overall mortality (aHR = 1.3; 95% CI, 1-1.5) and incident melanoma (aHR = 5.4; 95% CI, 2.9-9.8) after transplant.

Melanoma-specific mortality, incident melanoma and overall mortality had 10-year absolute risk differences of 2.97%, 3.68% and 14.32%, respectively.

Sixty-eight of the 144,441 patients with melanoma in the registries subsequently received a transplant.

While there was an increase in melanoma-specific mortality, the investigators said it was not significant (HR = 1.7; 95% CI, 0.61-4.5).

“The absolute incidence of posttransplant melanoma and melanoma-specific deaths were small but significantly increased, supporting a role for close dermatologic screening and follow-up after transplantation,” the researchers concluded. “Because our observation of an elevated overall mortality for transplant recipients with a history of melanoma is unexplained, listing committees should use a candidate’s history of melanoma as an indication that other factors may be present that predispose the patient to a poor transplant outcome, and incorporate this information into case-by-case decisions. These data will inform the development of consensus guidelines.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.