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NDT Advance Access originally published online on July 8, 2009
Nephrology Dialysis Transplantation 2009 24(10):3231-3235; doi:10.1093/ndt/gfp334
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Incidence of Merkel cell carcinoma in renal transplant recipients

Virve Koljonen1, Heli Kukko1, Erkki Tukiainen1, Tom Böhling2, Risto Sankila3, Eero Pukkala3, Harri Sihto4, Heikki Joensuu5, Lauri Kyllönen6 and Heikki Mäkisalo6

1 Department of Plastic Surgery, Helsinki University Hospital 2 Department of Pathology, Helsinki University and HUSLAB 3 Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research 4 Laboratory of Molecular Oncology, Biomedicum Helsinki 5 Department of Oncology 6 Division of Transplantation, 4th Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland

Correspondence and offprint requests to: Virve Koljonen; E-mail: virve.koljonen{at}hus.fi



  Abstract

Background. The risk factors for Merkel cell carcinoma (MCC), a rare type of skin cancer, are poorly understood. Some evidence suggests that MCC is more common in individuals with abnormal immune function resulting from viral infection, autoimmune disease or organ trans- plantation.

Methods. The national Renal Transplant Registry and the Finnish Cancer Registry data were searched for recipients of a renal transplant who were diagnosed with MCC. The MCC diagnoses were confirmed using immunohistochemistry.

Results. Three cases of MCC were detected among 4200 individuals who underwent renal transplantation from 1967 to 2005 [expected number 0.05, standardized incidence ratio (SIR) 66, 95% CI 14–194, P <0.001]. The latency period between the transplant and detection of MCC ranged from 6 to 19 years. In all three cases, the cause of transplantation was an autoimmune disease. All three died from aggressive MCC with a survival time ranging from 0.5 to 2.1 years.

Conclusions. The results indicate that the risk of MCC is greatly increased among subjects who have undergone renal transplantation. The course of the disease appears aggressive in this patient population. The physicians who treat recipients of a kidney transplant should be aware of the substantially increased risk of MCC.

Keywords: cancer registry; immunosuppression; kidney; population-based study; transplant registry

Received for publication: 10. 5.09
Accepted in revised form: 16. 6.09


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