Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

HLA Antigen Mismatch Linked with Skin Cancer Risk

JAMA Dermatology; ePub 2019 Jan 23; Gao, Twigg, et al

HLA antigen mismatch appears to be associated with reductions in the risk of skin cancer after solid-organ transplant among heart and lung transplant recipients, according to a recent retrospective cohort study. This finding suggests that HLA antigen mismatch activates the tumor surveillance mechanisms that protect against skin cancer in transplant recipients and that skin cancer risk may be higher in patients who received a well-matched organ. This study is a secondary analysis of the multicenter Transplant Skin Cancer Network study of adults who underwent a primary solid-organ transplant between January 1, 2003, and December 31, 2003, or between January 1, 2008, and December 31, 2008. Researchers found:

  • In total, 10,649 organ transplant recipients contributed 59,923 years of follow-up.
  • For each additional mismatched allele, a 7% to 8% reduction in skin cancer risk was found.
  • Subgroup analysis found the protective effect of HLA antigen mismatch to be statistically significant in lung and heart transplant recipients but not for recipients of liver, kidney, or pancreas.
  • The degree of HLA-DR mismatch, but not HLA-A or HLA-B mismatch, was the most statistically significant for skin cancer risk.


Gao Y, Twigg AR, Hirose R, et al. Association of HLA antigen mismatch with risk of developing skin cancer after solid-organ transplant. [Published online ahead of print January 23, 2019]. JAMA Dermatology. doi:10.1001/jamadermatol.2018.4983.