Duke University School of Medicine, Durham, North Carolina.
Department of Dermatology, Duke University Medical Center, Durham, North Carolina.
JAMA Dermatol. 2018 May 1;154(5):589-591. doi: 10.1001/jamadermatol.2018.0130.
The immunosuppression vital to maintaining transplanted organs comes with an increased incidence of cutaneous neoplasms. Understanding the genesis of malignant melanoma (MM) in transplant subpopulations is necessary for adequate disease surveillance.
To determine the incidence and timing of presentation of MM in the cardiothoracic (heart and/or lung) transplant (CTT) population.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cohort study of 1164 patients who underwent a CTT from 2001 through 2016 with a median follow-up time of 4.3 years. The study was performed at a single academic, tertiary referral center. The retrospective database was used to identify 1164 patients who underwent a CTT at Duke University Hospital from 2001 to 2016. Ten patients were excluded from the study owing to a history of MM, resulting in 1154 patients in the study. Five patients who developed MM after CTT were identified.
Exposures included tacrolimus, prednisone, and mycophenolate mofetil.
The primary outcome measurement was the MM incidence. Secondary outcomes included time to diagnosis and survival.
Five of 1154 patients who underwent a CTT (0.4%) developed biopsy-proven MM at a median follow-up time of 4.3 years after transplantation at a median age of 64.5 years (range, 31.0-74.0 years). Of the 1154 patients, 923 (80%) were men. Their mean (SD) age range was 63.8 years (27.2-68.2 years). Four patients (80%) presented with stage I disease while 1 (20%) presented with stage IV disease at a median time of 2.5 years (range, 0.1-5.3 years) after transplant compared with a median time of 6.2 years (range, 0.9-8.7 years) in Duke University's renal transplant population at a median follow-up time of 6.6 years. Two patients died after transplant, 1 owing to complications of the transplant and 1 owing to metastatic MM.
Representing one of the largest reported studies of patients with CTT developing MM, our findings suggest that the CTT population experiences an incidence of MM similar to that of other solid organ transplant recipients and with a median of 2.5 years from transplant to melanoma diagnosis. While the small scale of our study prevents far-reaching conclusions, further study is warranted to better understand the incidence, timing, and clinical ramifications of melanomagenesis in the CTT population.
维持移植器官所需的免疫抑制会增加皮肤肿瘤的发生率。了解移植人群中恶性黑色素瘤（MM）的发生机制对于充分的疾病监测是必要的。
确定心脏-肺移植（CTT）人群中 MM 的发病和表现时间。
设计、设置和参与者：这是一项回顾性队列研究，共纳入 1164 例 2001 年至 2016 年间接受 CTT 的患者，中位随访时间为 4.3 年。该研究在一家学术性三级转诊中心进行。通过回顾性数据库确定了 2001 年至 2016 年期间在杜克大学医院接受 CTT 的 1164 例患者。由于有 MM 病史，10 例患者被排除在研究之外，因此研究中有 1154 例患者。发现 5 例 CTT 后发生 MM 的患者。
暴露因素包括他克莫司、泼尼松和吗替麦考酚酯。
主要结局测量是 MM 的发病率。次要结局包括诊断时间和生存。
1154 例接受 CTT 的患者中，5 例（0.4%）在移植后中位随访时间为 4.3 年后，中位年龄为 64.5 岁（范围为 31.0-74.0 岁），经活检证实为 MM。在 1154 例患者中，923 例（80%）为男性。他们的平均（SD）年龄范围为 63.8 岁（27.2-68.2 岁）。4 例（80%）患者为 I 期疾病，1 例（20%）患者为 IV 期疾病，中位发病时间为移植后 2.5 年（范围为 0.1-5.3 年），而在中位随访时间为 6.6 年的杜克大学肾移植人群中，中位发病时间为 6.2 年（范围为 0.9-8.7 年）。2 例患者在移植后死亡，1 例死于移植并发症，1 例死于转移性 MM。
本研究是对接受 CTT 的 MM 患者进行的最大规模之一的研究，结果表明，CTT 人群的 MM 发病率与其他实体器官移植受者相似，从移植到黑色素瘤诊断的中位时间为 2.5 年。尽管我们的研究规模较小，无法得出广泛的结论，但仍需要进一步研究以更好地了解 CTT 人群中黑色素瘤发生的发生率、时间和临床后果。
