Incidence of and risk factors for skin cancer in organ transplant recipients in the United States

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 & 47 others 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

Research output: Contribution to journalArticle

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Abstract

IMPORTANCE Skin cancer is the most common malignancy occurring after organ transplantation. Although previous research has reported an increased risk of skin cancer in solid organ transplant recipients (OTRs), no study has estimated the posttransplant population-based incidence in the United States. OBJECTIVE To determine the incidence and evaluate the risk factors for posttransplant skin cancer, including squamous cell carcinoma (SCC), melanoma (MM), and Merkel cell carcinoma (MCC) in a cohort of US OTRs receiving a primary organ transplant in 2003 or 2008. DESIGN, SETTING, AND PARTICIPANTS This multicenter retrospective cohort study examined 10 649 adult recipients of a primary transplant performed at 26 centers across the United States in the Transplant Skin Cancer Network during 1 of 2 calendar years (either 2003 or 2008) identified through the Organ Procurement and Transplantation Network (OPTN) database. Recipients of all organs except intestine were included, and the follow-up periods were 5 and 10 years. MAIN OUTCOMES AND MEASURES Incident skin cancerwas determined through detailed medical record review. Data on predictors were obtained from the OPTN database. The incidence rates for posttransplant skin cancer overall and for SCC, MM, and MCC were calculated per 100 000 person-years. Potential risk factors for posttransplant skin cancer were tested using multivariate Cox regression analysis to yield adjusted hazard ratios (HR). RESULTS Overall, 10 649 organ transplant recipients (mean [SD] age, 51 [12] years; 3873 women [36%] and 6776 men [64%]) contributed 59 923 years of follow-up. The incidence rates for posttransplant skin cancer was 1437 per 100 000 person-years. Specific subtype rates for SCC, MM, and MCC were 812, 75, and 2 per 100 000 person-years, respectively. Statistically significant risk factors for posttransplant skin cancer included pretransplant skin cancer (HR, 4.69; 95%CI, 3.26-6.73), male sex (HR, 1.56; 95%CI, 1.34-1.81), white race (HR, 9.04; 95%CI, 6.20-13.18), age at transplant 50 years or older (HR, 2.77; 95%CI, 2.20-3.48), and being transplanted in 2008 vs 2003 (HR, 1.53; 95%CI, 1.22-1.94). CONCLUSIONS AND RELEVANCE Posttransplant skin cancer is common, with elevated risk imparted by increased age, white race, male sex, and thoracic organ transplantation. A temporal cohort effect was present. Understanding the risk factors and trends in posttransplant skin cancer is fundamental to targeted screening and prevention in this population.

Original languageEnglish (US)
Pages (from-to)296-303
Number of pages8
JournalJAMA Dermatology
Volume153
Issue number3
DOIs
StatePublished - Mar 1 2017

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Skin Neoplasms
Transplants
Incidence
Organ Transplantation
Merkel Cell Carcinoma
Squamous Cell Carcinoma
Melanoma
Tissue and Organ Procurement
Transplant Recipients
Databases
Cohort Effect
Sex Ratio
Population
Intestines
Medical Records
Cohort Studies
Thorax
Retrospective Studies
Regression Analysis
Skin

All Science Journal Classification (ASJC) codes

  • Dermatology

Cite this

Garrett, G. L., Blanc, P. D., Boscardin, J., Lloyd, A. A., Ahmed, R. L., Anthony, T., ... Arron, S. T. (2017). Incidence of and risk factors for skin cancer in organ transplant recipients in the United States. JAMA Dermatology, 153(3), 296-303. https://doi.org/10.1001/jamadermatol.2016.4920
Garrett, Giorgia L. ; Blanc, Paul D. ; Boscardin, John ; Lloyd, Amanda Abramson ; Ahmed, Rehana L. ; Anthony, Tiffany ; Bibee, Kristin ; Breithaupt, Andrew ; Cannon, Jennifer ; Chen, Amy ; Cheng, Joyce Y. ; Chiesa-Fuxench, Zelma ; Colegio, Oscar R. ; Curiel-Lewandrowski, Clara ; Del Guzzo, Christina A. ; Disse, Max ; Dowd, Margaret ; Eilers, Robert ; Ortiz, Arisa Elena ; Morris, Caroline ; Golden, Spring K. ; Graves, Michael S. ; Griffin, John R. ; Hopkins, R. Samuel ; Huang, Conway C. ; Bae, Gordon Hyeonjin ; Jambusaria, Anokhi ; Jennings, Thomas A. ; Jiang, Shang I.Brian ; Karia, Pritesh S. ; Khetarpal, Shilpi ; Kim, Changhyun ; Klintmalm, Goran ; Konicke, Kathryn ; Koyfman, Shlomo A. ; Lam, Charlene ; Lee, Peter ; Leitenberger, Justin J. ; Loh, Tiffany ; Lowenstein, Stefan ; Madankumar, Reshmi ; Moreau, Jacqueline F. ; Nijhawan, Rajiv I. ; Ochoa, Shari ; Olasz, Edit B. ; Otchere, Elaine ; Otley, Clark ; Oulton, Jeremy ; Patel, Parth H. ; Patel, Vishal Anil ; Prabhu, Arpan V. ; Pugliano-Mauro, Melissa ; Schmults, Chrysalyne D. ; Schram, Sarah ; Shih, Allen F. ; Shin, Thuzar ; Soon, Seaver ; Soriano, Teresa ; Srivastava, Divya ; Stein, Jennifer A. ; Sternhell-Blackwell, Kara ; Taylor, Stan ; Vidimos, Allison ; Wu, Peggy ; Zajdel, Nicholas ; Zelac, Daniel ; Arron, Sarah T. / Incidence of and risk factors for skin cancer in organ transplant recipients in the United States. In: JAMA Dermatology. 2017 ; Vol. 153, No. 3. pp. 296-303.
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title = "Incidence of and risk factors for skin cancer in organ transplant recipients in the United States",
abstract = "IMPORTANCE Skin cancer is the most common malignancy occurring after organ transplantation. Although previous research has reported an increased risk of skin cancer in solid organ transplant recipients (OTRs), no study has estimated the posttransplant population-based incidence in the United States. OBJECTIVE To determine the incidence and evaluate the risk factors for posttransplant skin cancer, including squamous cell carcinoma (SCC), melanoma (MM), and Merkel cell carcinoma (MCC) in a cohort of US OTRs receiving a primary organ transplant in 2003 or 2008. DESIGN, SETTING, AND PARTICIPANTS This multicenter retrospective cohort study examined 10 649 adult recipients of a primary transplant performed at 26 centers across the United States in the Transplant Skin Cancer Network during 1 of 2 calendar years (either 2003 or 2008) identified through the Organ Procurement and Transplantation Network (OPTN) database. Recipients of all organs except intestine were included, and the follow-up periods were 5 and 10 years. MAIN OUTCOMES AND MEASURES Incident skin cancerwas determined through detailed medical record review. Data on predictors were obtained from the OPTN database. The incidence rates for posttransplant skin cancer overall and for SCC, MM, and MCC were calculated per 100 000 person-years. Potential risk factors for posttransplant skin cancer were tested using multivariate Cox regression analysis to yield adjusted hazard ratios (HR). RESULTS Overall, 10 649 organ transplant recipients (mean [SD] age, 51 [12] years; 3873 women [36{\%}] and 6776 men [64{\%}]) contributed 59 923 years of follow-up. The incidence rates for posttransplant skin cancer was 1437 per 100 000 person-years. Specific subtype rates for SCC, MM, and MCC were 812, 75, and 2 per 100 000 person-years, respectively. Statistically significant risk factors for posttransplant skin cancer included pretransplant skin cancer (HR, 4.69; 95{\%}CI, 3.26-6.73), male sex (HR, 1.56; 95{\%}CI, 1.34-1.81), white race (HR, 9.04; 95{\%}CI, 6.20-13.18), age at transplant 50 years or older (HR, 2.77; 95{\%}CI, 2.20-3.48), and being transplanted in 2008 vs 2003 (HR, 1.53; 95{\%}CI, 1.22-1.94). CONCLUSIONS AND RELEVANCE Posttransplant skin cancer is common, with elevated risk imparted by increased age, white race, male sex, and thoracic organ transplantation. A temporal cohort effect was present. Understanding the risk factors and trends in posttransplant skin cancer is fundamental to targeted screening and prevention in this population.",
author = "Garrett, {Giorgia L.} and Blanc, {Paul D.} and John Boscardin and Lloyd, {Amanda Abramson} and Ahmed, {Rehana L.} and Tiffany Anthony and Kristin Bibee and Andrew Breithaupt and Jennifer Cannon and Amy Chen and Cheng, {Joyce Y.} and Zelma Chiesa-Fuxench and Colegio, {Oscar R.} and Clara Curiel-Lewandrowski and {Del Guzzo}, {Christina A.} and Max Disse and Margaret Dowd and Robert Eilers and Ortiz, {Arisa Elena} and Caroline Morris and Golden, {Spring K.} and Graves, {Michael S.} and Griffin, {John R.} and Hopkins, {R. Samuel} and Huang, {Conway C.} and Bae, {Gordon Hyeonjin} and Anokhi Jambusaria and Jennings, {Thomas A.} and Jiang, {Shang I.Brian} and Karia, {Pritesh S.} and Shilpi Khetarpal and Changhyun Kim and Goran Klintmalm and Kathryn Konicke and Koyfman, {Shlomo A.} and Charlene Lam and Peter Lee and Leitenberger, {Justin J.} and Tiffany Loh and Stefan Lowenstein and Reshmi Madankumar and Moreau, {Jacqueline F.} and Nijhawan, {Rajiv I.} and Shari Ochoa and Olasz, {Edit B.} and Elaine Otchere and Clark Otley and Jeremy Oulton and Patel, {Parth H.} and Patel, {Vishal Anil} and Prabhu, {Arpan V.} and Melissa Pugliano-Mauro and Schmults, {Chrysalyne D.} and Sarah Schram and Shih, {Allen F.} and Thuzar Shin and Seaver Soon and Teresa Soriano and Divya Srivastava and Stein, {Jennifer A.} and Kara Sternhell-Blackwell and Stan Taylor and Allison Vidimos and Peggy Wu and Nicholas Zajdel and Daniel Zelac and Arron, {Sarah T.}",
year = "2017",
month = "3",
day = "1",
doi = "10.1001/jamadermatol.2016.4920",
language = "English (US)",
volume = "153",
pages = "296--303",
journal = "JAMA Dermatology",
issn = "2168-6068",
publisher = "American Medical Association",
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Garrett, GL, Blanc, PD, Boscardin, J, Lloyd, AA, Ahmed, RL, Anthony, T, Bibee, K, Breithaupt, A, Cannon, J, Chen, A, Cheng, JY, Chiesa-Fuxench, Z, Colegio, OR, Curiel-Lewandrowski, C, Del Guzzo, CA, Disse, M, Dowd, M, Eilers, R, Ortiz, AE, Morris, C, Golden, SK, Graves, MS, Griffin, JR, Hopkins, RS, Huang, CC, Bae, GH, Jambusaria, A, Jennings, TA, Jiang, SIB, Karia, PS, Khetarpal, S, Kim, C, Klintmalm, G, Konicke, K, Koyfman, SA, Lam, C, Lee, P, Leitenberger, JJ, Loh, T, Lowenstein, S, Madankumar, R, Moreau, JF, Nijhawan, RI, Ochoa, S, Olasz, EB, Otchere, E, Otley, C, Oulton, J, Patel, PH, Patel, VA, Prabhu, AV, Pugliano-Mauro, M, Schmults, CD, Schram, S, Shih, AF, Shin, T, Soon, S, Soriano, T, Srivastava, D, Stein, JA, Sternhell-Blackwell, K, Taylor, S, Vidimos, A, Wu, P, Zajdel, N, Zelac, D & Arron, ST 2017, 'Incidence of and risk factors for skin cancer in organ transplant recipients in the United States', JAMA Dermatology, vol. 153, no. 3, pp. 296-303. https://doi.org/10.1001/jamadermatol.2016.4920

Incidence of and risk factors for skin cancer in organ transplant recipients in the United States. / Garrett, Giorgia L.; Blanc, Paul D.; Boscardin, John; Lloyd, Amanda Abramson; Ahmed, Rehana L.; Anthony, Tiffany; Bibee, Kristin; Breithaupt, Andrew; Cannon, Jennifer; Chen, Amy; Cheng, Joyce Y.; Chiesa-Fuxench, Zelma; Colegio, Oscar R.; Curiel-Lewandrowski, Clara; Del Guzzo, Christina A.; Disse, Max; Dowd, Margaret; Eilers, Robert; Ortiz, Arisa Elena; Morris, Caroline; Golden, Spring K.; Graves, Michael S.; Griffin, John R.; Hopkins, R. Samuel; Huang, Conway C.; Bae, Gordon Hyeonjin; Jambusaria, Anokhi; Jennings, Thomas A.; Jiang, Shang I.Brian; Karia, Pritesh S.; Khetarpal, Shilpi; Kim, Changhyun; Klintmalm, Goran; Konicke, Kathryn; Koyfman, Shlomo A.; Lam, Charlene; Lee, Peter; Leitenberger, Justin J.; Loh, Tiffany; Lowenstein, Stefan; Madankumar, Reshmi; Moreau, Jacqueline F.; Nijhawan, Rajiv I.; Ochoa, Shari; Olasz, Edit B.; Otchere, Elaine; Otley, Clark; Oulton, Jeremy; Patel, Parth H.; Patel, Vishal Anil; Prabhu, Arpan V.; Pugliano-Mauro, Melissa; Schmults, Chrysalyne D.; Schram, Sarah; Shih, Allen F.; Shin, Thuzar; Soon, Seaver; Soriano, Teresa; Srivastava, Divya; Stein, Jennifer A.; Sternhell-Blackwell, Kara; Taylor, Stan; Vidimos, Allison; Wu, Peggy; Zajdel, Nicholas; Zelac, Daniel; Arron, Sarah T.

In: JAMA Dermatology, Vol. 153, No. 3, 01.03.2017, p. 296-303.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incidence of and risk factors for skin cancer in organ transplant recipients in the United States

AU - Garrett, Giorgia L.

AU - Blanc, Paul D.

AU - Boscardin, John

AU - Lloyd, Amanda Abramson

AU - Ahmed, Rehana L.

AU - Anthony, Tiffany

AU - Bibee, Kristin

AU - Breithaupt, Andrew

AU - Cannon, Jennifer

AU - Chen, Amy

AU - Cheng, Joyce Y.

AU - Chiesa-Fuxench, Zelma

AU - Colegio, Oscar R.

AU - Curiel-Lewandrowski, Clara

AU - Del Guzzo, Christina A.

AU - Disse, Max

AU - Dowd, Margaret

AU - Eilers, Robert

AU - Ortiz, Arisa Elena

AU - Morris, Caroline

AU - Golden, Spring K.

AU - Graves, Michael S.

AU - Griffin, John R.

AU - Hopkins, R. Samuel

AU - Huang, Conway C.

AU - Bae, Gordon Hyeonjin

AU - Jambusaria, Anokhi

AU - Jennings, Thomas A.

AU - Jiang, Shang I.Brian

AU - Karia, Pritesh S.

AU - Khetarpal, Shilpi

AU - Kim, Changhyun

AU - Klintmalm, Goran

AU - Konicke, Kathryn

AU - Koyfman, Shlomo A.

AU - Lam, Charlene

AU - Lee, Peter

AU - Leitenberger, Justin J.

AU - Loh, Tiffany

AU - Lowenstein, Stefan

AU - Madankumar, Reshmi

AU - Moreau, Jacqueline F.

AU - Nijhawan, Rajiv I.

AU - Ochoa, Shari

AU - Olasz, Edit B.

AU - Otchere, Elaine

AU - Otley, Clark

AU - Oulton, Jeremy

AU - Patel, Parth H.

AU - Patel, Vishal Anil

AU - Prabhu, Arpan V.

AU - Pugliano-Mauro, Melissa

AU - Schmults, Chrysalyne D.

AU - Schram, Sarah

AU - Shih, Allen F.

AU - Shin, Thuzar

AU - Soon, Seaver

AU - Soriano, Teresa

AU - Srivastava, Divya

AU - Stein, Jennifer A.

AU - Sternhell-Blackwell, Kara

AU - Taylor, Stan

AU - Vidimos, Allison

AU - Wu, Peggy

AU - Zajdel, Nicholas

AU - Zelac, Daniel

AU - Arron, Sarah T.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - IMPORTANCE Skin cancer is the most common malignancy occurring after organ transplantation. Although previous research has reported an increased risk of skin cancer in solid organ transplant recipients (OTRs), no study has estimated the posttransplant population-based incidence in the United States. OBJECTIVE To determine the incidence and evaluate the risk factors for posttransplant skin cancer, including squamous cell carcinoma (SCC), melanoma (MM), and Merkel cell carcinoma (MCC) in a cohort of US OTRs receiving a primary organ transplant in 2003 or 2008. DESIGN, SETTING, AND PARTICIPANTS This multicenter retrospective cohort study examined 10 649 adult recipients of a primary transplant performed at 26 centers across the United States in the Transplant Skin Cancer Network during 1 of 2 calendar years (either 2003 or 2008) identified through the Organ Procurement and Transplantation Network (OPTN) database. Recipients of all organs except intestine were included, and the follow-up periods were 5 and 10 years. MAIN OUTCOMES AND MEASURES Incident skin cancerwas determined through detailed medical record review. Data on predictors were obtained from the OPTN database. The incidence rates for posttransplant skin cancer overall and for SCC, MM, and MCC were calculated per 100 000 person-years. Potential risk factors for posttransplant skin cancer were tested using multivariate Cox regression analysis to yield adjusted hazard ratios (HR). RESULTS Overall, 10 649 organ transplant recipients (mean [SD] age, 51 [12] years; 3873 women [36%] and 6776 men [64%]) contributed 59 923 years of follow-up. The incidence rates for posttransplant skin cancer was 1437 per 100 000 person-years. Specific subtype rates for SCC, MM, and MCC were 812, 75, and 2 per 100 000 person-years, respectively. Statistically significant risk factors for posttransplant skin cancer included pretransplant skin cancer (HR, 4.69; 95%CI, 3.26-6.73), male sex (HR, 1.56; 95%CI, 1.34-1.81), white race (HR, 9.04; 95%CI, 6.20-13.18), age at transplant 50 years or older (HR, 2.77; 95%CI, 2.20-3.48), and being transplanted in 2008 vs 2003 (HR, 1.53; 95%CI, 1.22-1.94). CONCLUSIONS AND RELEVANCE Posttransplant skin cancer is common, with elevated risk imparted by increased age, white race, male sex, and thoracic organ transplantation. A temporal cohort effect was present. Understanding the risk factors and trends in posttransplant skin cancer is fundamental to targeted screening and prevention in this population.

AB - IMPORTANCE Skin cancer is the most common malignancy occurring after organ transplantation. Although previous research has reported an increased risk of skin cancer in solid organ transplant recipients (OTRs), no study has estimated the posttransplant population-based incidence in the United States. OBJECTIVE To determine the incidence and evaluate the risk factors for posttransplant skin cancer, including squamous cell carcinoma (SCC), melanoma (MM), and Merkel cell carcinoma (MCC) in a cohort of US OTRs receiving a primary organ transplant in 2003 or 2008. DESIGN, SETTING, AND PARTICIPANTS This multicenter retrospective cohort study examined 10 649 adult recipients of a primary transplant performed at 26 centers across the United States in the Transplant Skin Cancer Network during 1 of 2 calendar years (either 2003 or 2008) identified through the Organ Procurement and Transplantation Network (OPTN) database. Recipients of all organs except intestine were included, and the follow-up periods were 5 and 10 years. MAIN OUTCOMES AND MEASURES Incident skin cancerwas determined through detailed medical record review. Data on predictors were obtained from the OPTN database. The incidence rates for posttransplant skin cancer overall and for SCC, MM, and MCC were calculated per 100 000 person-years. Potential risk factors for posttransplant skin cancer were tested using multivariate Cox regression analysis to yield adjusted hazard ratios (HR). RESULTS Overall, 10 649 organ transplant recipients (mean [SD] age, 51 [12] years; 3873 women [36%] and 6776 men [64%]) contributed 59 923 years of follow-up. The incidence rates for posttransplant skin cancer was 1437 per 100 000 person-years. Specific subtype rates for SCC, MM, and MCC were 812, 75, and 2 per 100 000 person-years, respectively. Statistically significant risk factors for posttransplant skin cancer included pretransplant skin cancer (HR, 4.69; 95%CI, 3.26-6.73), male sex (HR, 1.56; 95%CI, 1.34-1.81), white race (HR, 9.04; 95%CI, 6.20-13.18), age at transplant 50 years or older (HR, 2.77; 95%CI, 2.20-3.48), and being transplanted in 2008 vs 2003 (HR, 1.53; 95%CI, 1.22-1.94). CONCLUSIONS AND RELEVANCE Posttransplant skin cancer is common, with elevated risk imparted by increased age, white race, male sex, and thoracic organ transplantation. A temporal cohort effect was present. Understanding the risk factors and trends in posttransplant skin cancer is fundamental to targeted screening and prevention in this population.

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DO - 10.1001/jamadermatol.2016.4920

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SP - 296

EP - 303

JO - JAMA Dermatology

JF - JAMA Dermatology

SN - 2168-6068

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