With a transplanted kidney, I must take immunosuppressant drugs for life to help prevent rejection of the organ. Such drugs, though, makes it twice as likely for me to develop melanoma as compared to non-transplanted people, and three times more likely to die of the dangerous skin cancer.
According to recent findings reported in the Journal of Investigative Dermatology, the immunosuppressive medications that transplant recipients receive — especially the high doses administered at the time of transplant — make them more susceptible to later stage cancers that are harder to cure. Transplant recipients were four times more likely to be diagnosed with later stage melanoma already spreading to other parts of the body.
The researchers studied 139,991 white transplant recipients in the Transplant Cancer Match Study at the National Cancer Institute. They found 519 melanomas in this group.
They then compared outcomes among 182 melanoma of those transplanted patients with more than 130,000 other people with melanoma. Over 15 years, 27 percent of the transplant recipients died of their melanoma, as compared to 12 percent of the non-recipients. The researchers found that melanoma patients with a transplant were three times more likely to die from their melanoma, even for melanomas diagnosed at an early stage or were very small.
Risk of aggressive melanomas was highest within the first four years after transplant. Previously, researchers thought that immunosuppressants might act cumulatively, making these cancers more likely after years of taking the drugs. But, the researchers found that late-stage melanomas were associated with use of medication given at the time of transplant to stop T-cells — the main cells of immune response — from functioning to keep them from attacking the new organ.
Some types of cancer are more common among immune-suppressed people, typically cancers linked to viruses like cervical cancer and lymphoma. Melanoma is linked to exposure to ultraviolet rays from the sun rather than to a virus.
Transplant candidates should be screened carefully before transplant surgery to detect melanomas already present and that could spread rapidly when immunosuppressive drugs are given. Also, monitoring after transplant could allow melanoma to be detected earlier, preventing patients from developing deadly metastatic cancer.