Outcomes of malignant melanoma in kidney transplant recipients

Kidney transplant recipients (KTRs) have an increased risk of skin cancer. We analyzed the outcomes of KTRs transplanted at our center between January 1, 1994, and December 31, 2015, who reported pretransplant melanoma or had post-transplant de novo melanoma. Of 6,522 kidney or kidney with pancreas transplant recipients, 37 had pretransplant melanoma. After adjustment of multiple variables, pretransplant melanoma was associated with overall increased risk of death (HR: 1.75, 95% CI 1.02 - 3.03, p = 0.04) but not for death-censored graft failure (DCGF). A total of 46 patients developed post-transplant de novo melanoma. After adjustment of multiple variables, post-transplant de novo melanoma was associated with significant risk for death within the first year of the diagnosis of melanoma (HR: 4.40, 95% CI 2.21 - 8.74, p < 0.001), and DCGF after the first year (HR: 1.93, 95% CI 1.13 - 3.64, p = 0.04). Similarly, among all pretransplant candidates (including those with history of melanoma) in Cox regression multivariate analysis, older age (HR: 1.32, 95% CI 0.31 - 1.14, p = 0.04) and a history of pretransplant melanoma (HR: 9.27, 95% CI 2.81 - 30.53, p < 0.001) were significantly associated with the risk for development of post-transplant melanoma. Proper risk stratification and early diagnosis may improve patient and graft survival.