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HLA Mismatch and Skin Cancer Risk After Organ Transplant

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Key Points

  • For each additional mismatched allele, researchers found a 7% to 8% reduction in risk of skin cancer.
  • Subgroup analysis found the protective effect of HLA antigen mismatch statistically significant in patients who underwent lung and heart transplants, but not in patients who underwent liver, kidney, or pancreas transplants.
  • Degree of HLA-DR mismatch was the most statistically significant for skin cancer risk.

Data on the risk factors for the development of skin cancer after a solid organ transplant are limited. In a retrospective cohort study, researchers sought to determine the relationship between human leukocyte antigen (HLA) mismatch and risk of skin cancer after transplant. Their findings were published by Gao et al in JAMA Dermatology.

Methods

Researchers performed a secondary analysis of the Transplant Skin Cancer Network study of 10,649 patients who underwent a primary solid organ transplant. The primary outcome was time to diagnosis of skin cancer—either squamous cell carcinoma, melanoma, and Merkel cell carcinoma—after transplant. HLA antigen mismatch was calculated based on the 2016 Organ Procurement and Transplantation Network guidelines.

Of the transplant recipients included in the study, 63.6% were men, and the mean age was 51 years.

Findings

For each additional mismatched allele, researchers found a 7% to 8% reduction in risk of skin cancer (adjusted hazard ratio [HR] = 0.93; 95% confidence interval [CI] = 0.87–0.99; P  =  .01). Subgroup analysis found the protective effect of HLA antigen mismatch statistically significant in patients who underwent lung and heart transplants, but not in patients who underwent liver, kidney, or pancreas transplants. Degree of HLA-DR mismatch was the most statistically significant for skin cancer risk over HLA-A or HLA-B mismatch (adjusted HR = 0.85; 95% CI = 0.74–0.97; P  =  .01).

The authors concluded, “The HLA antigen mismatch appears to be associated with reductions in the risk of skin cancer after solid-organ transplant among heart and lung transplant recipients; this finding suggests that HLA antigen mismatch activates the tumor surveillance mechanisms that protect against skin cancer in transplant recipients and that skin cancer risk may be higher in patients who received a well-matched organ.”

Disclosure: The study authors' full disclosures can be found at jamanetwork.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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