Original article
Melanoma incidence, stage, and survival after solid organ transplant: A population-based cohort study in Ontario, Canada

https://doi.org/10.1016/j.jaad.2019.09.072Get rights and content

Background

Risk of melanoma is increased with potentially worse outcomes after solid organ transplant.

Objective

To estimate the incidence, stage, and survival in transplant recipients with melanoma.

Methods

Population-based, retrospective, observational study using linked administrative databases. Adults receiving their first solid organ transplant from 1991 through 2012 were followed to December 2013.

Results

We identified 51 transplant recipients with melanoma, 11 369 recipients without melanoma, and 255 matched patients with melanoma from the nontransplant population. Transplant recipients were at increased risk of melanoma (standardized incidence ratio, 2.29; 95% confidence interval [CI], 2.07-2.49) and more likely to be diagnosed at stages II through IV (adjusted odds ratio, 4.29; 95% CI, 2.04-9.00) compared with the nontransplant population. Melanoma-specific mortality was increased in transplant recipients compared with the nontransplant population (adjusted hazard ratio, 1.93; 95% CI, 1.03-3.63). Among transplant recipients, all-cause mortality was increased after melanoma compared with those without melanoma (stage T1/T2: adjusted hazard ratio, 2.18; 95% CI, 1.13-4.21; T3/T4: adjusted hazard ratio, 4.07; 95% CI, 2.36-7.04; III/IV: adjusted hazard ratio, 7.92; 95% CI, 3.76-16.70).

Limitations

The databases did not contain data on immunosuppressive drugs; ascertainment of melanoma metastasis relied on pathology reports.

Conclusion

Melanoma after solid organ transplant is more often diagnosed at a later stage and leads to increased mortality, even for early-stage tumors.

Section snippets

Patients and methods

We conducted a retrospective, observational, inception cohort study using population-based administrative health databases that were linked using unique encoded identifiers at ICES in Toronto, Canada. Approval of the study was granted by the Women's College Hospital Research Ethics Board, which allowed a consent waiver as we used deidentified administrative databases held securely at ICES.

Using the Canadian Organ Replacement Register, which records data on all transplants in Canada, we

Results

A total of 19 910 patients received a solid organ transplant in Ontario between 1991 and 2012. Exclusions were made based on the following criteria: not the first transplant (n = 1888), residence outside of Ontario (n = 4429), age younger than 18 years (n = 1128), bowel transplant (n = 13), pretransplant melanoma (n = 29), death within 90 days after transplant (n = 564), and kidney graft failure within 90 days (n = 439). The final transplant cohort consisted of 11 420 patients whose

Discussion

In this population-based cohort study, we found that solid organ transplant recipients had a significantly greater risk of developing melanoma overall and had melanoma diagnosed at a later stage than age- and sex-matched individuals from the nontransplant population. Posttransplant melanoma was also associated with lower melanoma-specific survival compared with melanoma in the nontransplant population. Transplant recipients who developed melanoma had an increased overall mortality compared with

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    Funding sources: Supported by the Canadian Dermatology Foundation. The work was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, views, and conclusions reported in this article are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred.

    Disclosure: Dr Austin is supported in part by a Mid-Career Investigator Award from the Heart & Stroke Foundation. Dr Rochon holds the Retired Teachers of Ontario/Les enseignantes et enseignants retraites de l'Ontario Chair in Geriatric Medicine from the University of Toronto. Drs Park and Dahlke, Ms Fung, Ms Kitchen, and Dr Chan have no conflicts of interest to declare.

    IRB approval status: Approved by Women's College Hospital.

    Reprints not available from the authors.

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