Table 3. Risk of Melanoma, Merkel Cell Carcinoma, and Adnexal Cancers in Transplant Recipients.
| Characteristic | Melanoma | Merkel cell carcinoma | Sebaceous carcinoma | Nonsebaceous adnexal cancers | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. (n = 1471) | IRR (95% CI)a | P value | No. (n = 334) | IRR (95% CI)a | P value | No. (n = 170) | IRR (95% CI)a | P value | No. (n = 84) | IRR (95% CI)a | P value | |
| Sex | ||||||||||||
| Female | 334 | 1 [Reference] | NA | 72 | 1 [Reference] | NA | 36 | 1 [Reference] | NA | 24 | 1 [Reference] | NA |
| Male | 1137 | 1.86 (1.65-2.11) | <.001 | 262 | 1.90 (1.46-2.48) | <.001 | 134 | 2.01 (1.38-2.91) | <.001 | 60 | 1.30 (0.81-2.11) | .28 |
| Race and ethnicity | ||||||||||||
| Asian or Pacific Islander | 6 | 0.05 (0.02-0.11) | <.001 | 5 | 0.23 (0.10-0.56) | .001 | 11 | 1.34 (0.71-2.52) | .37 | 2 | 0.33 (0.08-1.34) | .12 |
| Hispanic or Latino | 31 | 0.11 (0.08-0.16) | <.001 | 21 | 0.40 (0.25-0.63) | <.001 | 23 | 1.29 (0.80-2.08) | .30 | 4 | 0.25 (0.09-0.70) | .008 |
| Non-Hispanic Black | 15 | 0.05 (0.03-0.08) | <.001 | 5 | 0.09 (0.04-0.22) | <.001 | 9 | 0.41 (0.21-0.82) | .01 | 2 | 0.13 (0.03-0.54) | .005 |
| Non-Hispanic White | 1419 | 1 [Reference] | NA | 303 | 1 [Reference] | NA | 127 | 1 [Reference] | NA | 76 | 1 [Reference] | NA |
| Age at transplant, y | ||||||||||||
| 0-34 | 77 | 1 [Reference] | NA | 9 | 1 [Reference] | NA | 4 | 1 [Reference] | NA | 4 | 1 [Reference] | NA |
| 35-49 | 292 | 2.52 (1.96-3.25) | <.001 | 69 | 5.21 (2.60-10.4) | <.001 | 36 | 6.31 (2.24-17.7) | <.001 | 17 | 2.92 (0.98-8.71) | .05 |
| 50-64 | 776 | 5.31 (4.19-6.73) | <.001 | 177 | 11.4 (5.79-22.3) | <.001 | 95 | 13.2 (4.82-36.1) | <.001 | 45 | 6.13 (2.17-17.3) | .001 |
| ≥65 | 326 | 9.03 (7.01-11.6) | <.001 | 79 | 22.7 (11.3-45.8) | <.001 | 35 | 21.7 (7.62-62.0) | <.001 | 18 | 10.2 (3.35-30.9) | <.001 |
| P for trend | NA | NA | <.001 | NA | NA | <.001 | NA | NA | <.001 | NA | NA | <.001 |
| Transplanted organ | ||||||||||||
| Kidney | 814 | 1 [Reference] | NA | 206 | 1 [Reference] | NA | 97 | 1 [Reference] | 54 | 1 [Reference] | NA | |
| Liver | 273 | 0.65 (0.56-0.74) | <.001 | 46 | 0.46 (0.33-0.63) | <.001 | 21 | 0.44 (0.27-0.72) | .001 | 10 | 0.39 (0.19-0.77) | .007 |
| Heart and/or lung | 315 | 0.85 (0.74-0.98) | .02 | 72 | 0.71 (0.53-0.95) | .02 | 47 | 1.39 (0.95-2.04) | .09 | 19 | 0.75 (0.43-1.31) | .31 |
| Other or multiple | 69 | 0.93 (0.73-1.20) | .58 | 10 | 0.58 (0.30-1.10) | .09 | 5 | 0.61 (0.25-1.53) | .30 | 1 | 0.22 (0.03-1.59) | .13 |
| Maintenance immunosuppressive therapy | ||||||||||||
| Tacrolimus or mycophenolate mofetil without cyclosporine or azathioprine | 808 | 1 [Reference] | NA | 164 | 1 [Reference] | NA | 101 | 1 [Reference] | NA | 41 | 1 [Reference] | NA |
| Cyclosporine or azathioprine without tacrolimus or mycophenolate mofetil | 343 | 1.13 (0.95-1.36) | .17 | 103 | 0.94 (0.65-1.36) | .74 | 38 | 0.83 (0.50-1.39) | .48 | 27 | 1.22 (0.59-2.53) | .59 |
| Other medication combination | 320 | 1.10 (0.95-1.27) | .21 | 67 | 1.00 (0.72-1.38) | .99 | 31 | 0.66 (0.42-1.05) | .08 | 16 | 1.02 (0.53-1.96) | .95 |
| Exposure to mammalian target of rapamycin inhibitor | ||||||||||||
| No | 1413 | 1 [Reference] | NA | 307 | 1 [Reference] | NA | 160 | 1 [Reference] | NA | 77 | 1 [Reference] | NA |
| Yes | 58 | 0.75 (0.57-0.98) | .03 | 27 | 1.87 (1.24-2.81) | .003 | 10 | 1.14 (0.59-2.18) | .70 | 7 | 1.75 (0.78-3.93) | .17 |
| Posttransplant basal cell carcinoma | ||||||||||||
| No | 1378 | 1 [Reference] | NA | 294 | 1 [Reference] | NA | 156 | 1 [Reference] | NA | 74 | 1 [Reference] | NA |
| Yes | 93 | 1.81 (1.45-2.26) | <.001 | 40 | 2.30 (1.60-3.29) | <.001 | 14 | 1.59 (0.89-2.86) | .12 | 10 | 2.53 (1.23-5.20) | .01 |
| Posttransplant squamous cell carcinoma | ||||||||||||
| No | 1362 | 1 [Reference] | NA | 270 | 1 [Reference] | NA | 144 | 1 [Reference] | NA | 69 | 1 [Reference] | NA |
| Yes | 109 | 1.54 (1.25-1.90) | <.001 | 64 | 3.67 (2.70-4.99) | <.001 | 26 | 2.86 (1.80-4.54) | <.001 | 15 | 3.61 (1.92-6.76) | <.001 |
| Annual mean daily UVR exposureb | ||||||||||||
| Quartile | ||||||||||||
| 1 | 389 | 1 [Reference] | NA | 84 | 1 [Reference] | NA | 56 | 1 [Reference] | NA | 18 | 1 [Reference] | NA |
| 2 | 390 | 1.02 (0.88-1.17) | .81 | 75 | 0.90 (0.66-1.23) | .52 | 35 | 0.58 (0.38-0.88) | .01 | 18 | 1.00 (0.52-1.93) | >.99 |
| 3 | 382 | 1.19 (1.03-1.37) | .02 | 88 | 1.21 (0.90-1.64) | .21 | 45 | 0.79 (0.53-1.18) | .25 | 21 | 1.35 (0.72-2.54) | .36 |
| 4 | 310 | 1.21 (1.04-1.41) | .01 | 87 | 1.46 (1.08-1.99) | .02 | 34 | 0.65 (0.41-1.02) | .06 | 27 | 2.19 (1.19-4.02) | .01 |
| P for trend | NA | NA | .002 | NA | NA | .005 | NA | NA | .13 | NA | NA | .007 |
| Time since transplant, y | ||||||||||||
| Within 1 y | 140 | 1 [Reference] | NA | 15 | 1 [Reference] | NA | 3 | 1 [Reference] | NA | 4 | 1 [Reference] | NA |
| 1-4.9 | 595 | 1.32 (1.10-1.57) | .002 | 89 | 1.72 (1.04-2.84) | .04 | 51 | 6.40 (2.00-20.5) | .002 | 23 | 2.05 (0.71-5.88) | .18 |
| 5-9.9 | 439 | 1.43 (1.18-1.73) | <.001 | 123 | 2.73 (1.63-4.56) | <.001 | 58 | 10.7 (3.30-34.6) | <.001 | 34 | 3.64 (1.25-10.6) | .02 |
| ≥10 | 297 | 1.55 (1.24-1.93) | <.001 | 107 | 3.32 (1.92-5.76) | <.001 | 58 | 19.4 (5.87-64.5) | <.001 | 23 | 3.28 (1.02-10.5) | .046 |
| P for trend | NA | NA | <.001 | NA | NA | <.001 | NA | NA | <.001 | NA | NA | .02 |
Abbreviations: IRR, incidence rate ratio; NA, not applicable; UVR, UV radiation.
a
Results are from multivariate Poisson regression models that included the variables listed in the table as well as transplant number (first and second or later) and calendar year of transplant (1987-1994, 1995-2002, 2003-2010, and 2011-2017).
b
Quartile cutoffs for ambient UVR (4.6-26.3, 26.4-34.2, 34.3-45.5, and 45.6-84.1 mW/m2) were based on the UVR (UV-B, 305 nm) distribution among the transplant population.