Kidney Week

Abstract: SA-PO027

Outcomes of Kidney Transplant Recipients with Pre-Transplant, Recurrence, and Post-Transplant Malignant Melanoma

Session Information

• Transplantation: Clinical Outcomes
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Di Bartolomeo, Sarah Elizabeth, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

Sarah Elizabeth Di Bartolomeo,

• Rolak, Stacey, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

Stacey Rolak,

• Astor, Brad C., University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

Brad C. Astor,

• Parajuli, Sandesh, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States

Sandesh Parajuli,

Background

Kidney transplant recipients (KTRs) have an increased risk of malignancy, especially skin cancer. Patients with pre-transplant melanoma usually wait a longer period before transplantation than their counterparts with non-melanoma skin cancers as there is limited data on risk of recurrence and outcomes of pre, recurrent and post-transplant melanoma.

Methods

We analyzed the outcomes of KTRs transplanted at our center between 01/01/1994 and 12/31/2014 who reported pre-transplant melanoma, recurrence of melanoma after transplant and post-transplant melanoma.

Results

Of 4941 KTRs within the abovementioned time-period, thirty-four had a history of melanoma prior to renal transplant, of which 6 (18%) had recurrence of melanoma post-transplant. Mean wait time from melanoma diagnosis to transplant was 389 ± 311 days for non-recurrent patients and 422 ± 411 days (p=0.32). The mean interval to recurrence of melanoma was 6.2 ± 3.7 years after transplant. Five of the 6 patients with recurrence had end stage renal disease due to diabetes. All KTRs with or without recurrence were Caucasian. The cumulative incidence of biopsy-confirmed rejection was 50% (n=3) in those with recurrence, compared to 4% (n=1) in those without recurrence (p=<0.001). The mean interval from transplant to rejection was 2.9 ± 1.6 and 1.4 years respectively. The cumulative incidence of death censored graft loss was 17% (n=1) among recurrent melanoma patients with an interval from transplant to graft loss of 6.0 years while the incidence among only pre-transplant melanoma was 14% (n=4) with an interval of 5.0 ± 3.1 years. Similarly, there were a total of forty-five Caucasian KTRs with post-transplant melanoma. The mean interval from transplant to melanoma was 4.4 ± 3.1 years. The incidence of death censored graft loss was 11% (n=5) at last follow-up.

Conclusion

Recurrence of melanoma is common among KTRs with pre-transplant melanoma, especially among KTRs with diabetes. Incidence of biopsy proven rejection and graft failure among recurrent melanoma is high. Proper risk stratification and early diagnosis may improve patient and graft survival.