Department of Dermatology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
JAMA Dermatol. 2024 Feb 1;160(2):194-198. doi: 10.1001/jamadermatol.2023.4933.
Vitiligo is a multifactorial, depigmenting skin disorder characterized by selective loss of melanocytes. Large-scale studies are lacking to determine the risk of vitiligo in transplant recipients with graft-vs-host disease (GVHD).
To investigate the incidence rates and risk of vitiligo in patients who had received solid organ transplant (SOT) or hematopoietic stem cell transplant (HSCT) overall and by HSCT graft type and concomitant GVHD.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study included data from the National Health Insurance Service database of Korea for patients aged 20 years or older who had received a transplant (SOT or HSCT) between January 2010 and December 2017, with follow-up until December 2019. A cohort of age- and sex-matched (1:5) control individuals who did not receive a transplant was included for comparison. Data were analyzed from July 2021 to December 2021.
Transplant (SOT or HSCT) and GVHD.
The main outcome was risk of vitiligo, assessed using multivariable Cox proportional hazards regression analyses adjusting for potential confounding factors.
The study included 23 829 patients who had undergone SOT or HSCT (62.78% male; mean [SD] age, 49.58 [11.59] years) and 119 145 age- and sex-matched controls. Patients who had undergone transplant had a significantly higher risk of vitiligo compared with controls (adjusted hazard ratio [AHR], 1.73; 95% CI, 1.35-2.22). Risk of vitiligo was also slightly higher in kidney transplant recipients and liver transplant recipients compared with the controls but was highest in HSCT recipients (AHR, 12.69; 95% CI, 5.11-31.50). Patients who had received allogeneic grafts (AHR, 14.43; 95% CI, 5.61-37.15), those who had received autologous grafts (AHR, 5.71; 95% CI, 1.20-3.18), those with comorbid GVHD (AHR, 24.09; 95% CI, 9.16-63.35), and those without GVHD (AHR, 8.21; 95% CI, 3.08-21.87) had a higher risk of vitiligo compared with controls.
In this study, risk of vitiligo was significantly higher in transplant recipients, especially in HSCT recipients and those with allogeneic grafts or comorbid GVHD. These findings provide new insights into the association between the risk of vitiligo and transplant and GVHD. Clinicians should be aware of these risks, implementing a multidisciplinary approach for monitoring.
白癜风是一种多因素的色素减退性皮肤疾病，其特征是黑色素细胞的选择性丧失。目前缺乏大规模的研究来确定移植物抗宿主病（GVHD）患者接受器官移植或造血干细胞移植后白癜风的发病风险。
调查整体接受实体器官移植（SOT）或造血干细胞移植（HSCT）的患者以及根据 HSCT 移植物类型和同时发生的 GVHD 发生白癜风的发病率和风险。
设计、地点和参与者：这项基于人群的队列研究纳入了韩国国家健康保险服务数据库中 20 岁或以上在 2010 年 1 月至 2017 年 12 月期间接受移植（SOT 或 HSCT）的患者的数据，并随访至 2019 年 12 月。还纳入了一组年龄和性别匹配（1:5）的未接受移植的对照个体进行比较。数据分析于 2021 年 7 月至 2021 年 12 月进行。
移植（SOT 或 HSCT）和 GVHD。
主要结局是白癜风的发病风险，使用多变量 Cox 比例风险回归分析进行评估，调整了潜在混杂因素。
这项研究纳入了 23829 名接受 SOT 或 HSCT 的患者（62.78%为男性；平均[SD]年龄，49.58[11.59]岁）和 119145 名年龄和性别匹配的对照。与对照组相比，接受移植的患者发生白癜风的风险显著更高（调整后的危险比[AHR]，1.73；95%CI，1.35-2.22）。与对照组相比，肾移植受者和肝移植受者发生白癜风的风险也略高，但 HSCT 受者的风险最高（AHR，12.69；95%CI，5.11-31.50）。接受同种异体移植物的患者（AHR，14.43；95%CI，5.61-37.15）、接受自体移植物的患者（AHR，5.71；95%CI，1.20-3.18）、患有合并 GVHD 的患者（AHR，24.09；95%CI，9.16-63.35）和没有 GVHD 的患者（AHR，8.21；95%CI，3.08-21.87）发生白癜风的风险均高于对照组。
在这项研究中，移植受者发生白癜风的风险显著更高，尤其是 HSCT 受者以及接受同种异体移植物或合并 GVHD 的患者。这些发现为白癜风风险与移植和 GVHD 之间的关联提供了新的见解。临床医生应意识到这些风险，实施多学科方法进行监测。
