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Gao Y, Twigg AR, Hirose R, et al. Association of HLA Antigen Mismatch With Risk of Developing Skin Cancer After Solid-Organ Transplant. JAMA Dermatol. 2019;155(3):307–314. doi:10.1001/jamadermatol.2018.4983
What is the association between HLA antigen mismatch and the incidence of skin cancer after a solid-organ transplant?
In this secondary analysis of a cohort study of 10 649 organ transplant recipients, HLA antigen mismatch between a donor and a recipient was associated with a protective effect against posttransplant skin cancer after adjusting for age, sex, white race/ethnicity, thoracic organ transplant, year of transplant, and pretransplant history of skin cancer. Higher levels of HLA antigen mismatch reduced the risk of skin cancer after a solid-organ transplant in heart and lung transplant recipients.
Tumor surveillance mechanisms may be activated by HLA antigen mismatch, and well-matched heart and lung transplant recipients may have a higher risk of skin cancer after transplant.
Risk factors for the development of skin cancer after solid-organ transplant can inform clinical care, but data on these risk factors are limited.
To study the association between HLA antigen mismatch and skin cancer incidence after solid-organ transplant.
Design, Setting, and Participants
This retrospective cohort study is a secondary analysis of the multicenter Transplant Skin Cancer Network study of 10 649 adults who underwent a primary solid-organ transplant between January 1, 2003, and December 31, 2003, or between January 1, 2008, and December 31, 2008. These participants were identified through the Scientific Registry of Transplant Recipients standard analysis files, which contain data collected mostly by the Organ Procurement and Transplantation Network. Participants were matched to skin cancer outcomes by medical record review. This study was conducted from August 1, 2016, to July 31, 2017.
Main Outcomes and Measures
The primary outcome was time to diagnosis of posttransplant skin cancer, including squamous cell carcinoma, melanoma, and Merkel cell carcinoma. The HLA antigen mismatch was calculated based on the 2016 Organ Procurement and Transplantation Network guidelines. Risk of skin cancer was analyzed using a multivariate Cox proportional hazards regression model.
In total, 10 649 organ transplant recipients (6776 men [63.6%], with a mean [SD] age of 51  years) contributed 59 923 years of follow-up. For each additional mismatched allele, a 7% to 8% reduction in skin cancer risk was found (adjusted hazard ratio [HR], 0.93; 95% CI, 0.87-0.99; P = .01). Subgroup analysis found the protective effect of HLA antigen mismatch to be statistically significant in lung (adjusted HR, 0.70; 95% CI, 0.56-0.87; P = .001) and heart (adjusted HR, 0.75; 95% CI, 0.60-0.93; P = .008) transplant recipients but not for recipients of liver, kidney, or pancreas. The degree of HLA-DR mismatch, but not HLA-A or HLA-B mismatch, was the most statistically significant for skin cancer risk (adjusted HR, 0.85; 95% CI, 0.74-0.97; P = .01).
Conclusions and Relevance
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.
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