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J Natl Cancer Inst. 2015 Jan 8;107(2). pii: dju382. doi: 10.1093/jnci/dju382. Print 2015 Feb.

Risk of merkel cell carcinoma after solid organ transplantation.

Author information

1
Cancer Prevention Institute of California, Fremont, CA (CAC); Department of Health Research and Policy, Stanford University School of Medicine and Stanford Cancer Institute, Palo Alto, CA (CAC); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (HAR, ZT, JFFJr, EAE); Department of Epidemiology, University of Iowa, Iowa City, IA (CFL); New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ (KSP); Colorado Central Cancer Registry, Colorado Department of Public Health and Environment, Denver, CO (JLF); University of Hawaii Cancer Center, Honolulu, HI (BYH); Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA (MMM); Department of Epidemiology, University of Washington, Seattle, WA (MMM). tina@cpic.org.
2
Cancer Prevention Institute of California, Fremont, CA (CAC); Department of Health Research and Policy, Stanford University School of Medicine and Stanford Cancer Institute, Palo Alto, CA (CAC); Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (HAR, ZT, JFFJr, EAE); Department of Epidemiology, University of Iowa, Iowa City, IA (CFL); New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ (KSP); Colorado Central Cancer Registry, Colorado Department of Public Health and Environment, Denver, CO (JLF); University of Hawaii Cancer Center, Honolulu, HI (BYH); Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA (MMM); Department of Epidemiology, University of Washington, Seattle, WA (MMM).

Abstract

BACKGROUND:

Solid organ transplant recipients have elevated risks of virus-related cancers, in part because of long-term immunosuppression. Merkel cell carcinoma (MCC) is an aggressive skin cancer recently found to have a viral origin, but little is known regarding the occurrence of MCC after transplant.

METHODS:

We linked the US Scientific Registry of Transplant Recipients with data from 15 population-based cancer registries to ascertain MCC occurrence among 189498 solid organ transplant recipients from 1987 to 2009. Risks for MCC following transplantation were compared with the general population using standardized incidence ratios, and Poisson regression was used to compare incidence rates according to key patient and transplant characteristics. All statistical tests were two-sided.

RESULTS:

After solid organ transplantation, overall risk of MCC was increased 23.8-fold (95% confidence interval = 19.6 to 28.7, n = 110). Adjusted risks were highest among older recipients, increased with time since transplantation, and varied by organ type (all P ≤ .007). Azathioprine, cyclosporine, and mTOR inhibitors given for maintenance immunosuppression increased risk, and non-Hispanic white recipients on cyclosporine and azathioprine experienced increasing MCC risk with lower latitude of residence (ie, higher ultraviolet radiation exposure, P = .012).

CONCLUSIONS:

MCC risk is sharply elevated after solid organ transplant, likely resulting from long-term immunosuppression. Immunosuppressive medications may act synergistically with ultraviolet radiation to increase risk.

PMID:
25575645
PMCID:
PMC4311175
DOI:
10.1093/jnci/dju382
[Indexed for MEDLINE]
Free PMC Article

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