JAMA Dermatology

<jats:sec id="ab-dbr230020-4"><jats:title>Importance</jats:title><jats:p>Vitiligo is a multifactorial, depigmenting skin disorder characterized by selective loss of melanocytes. Large-scale studies are lacking to determine the risk of vitiligo in transplant recipients with graft-vs-host disease (GVHD).</jats:p></jats:sec><jats:sec id="ab-dbr230020-5"><jats:title>Objective</jats:title><jats:p>To investigate the incidence rates and risk of vitiligo in patients who had received solid organ transplant (SOT) or hematopoietic stem cell transplant (HSCT) overall and by HSCT graft type and concomitant GVHD.</jats:p></jats:sec><jats:sec id="ab-dbr230020-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This population-based cohort study included data from the National Health Insurance Service database of Korea for patients aged 20 years or older who had received a transplant (SOT or HSCT) between January 2010 and December 2017, with follow-up until December 2019. A cohort of age- and sex-matched (1:5) control individuals who did not receive a transplant was included for comparison. Data were analyzed from July 2021 to December 2021.</jats:p></jats:sec><jats:sec id="ab-dbr230020-7"><jats:title>Exposure</jats:title><jats:p>Transplant (SOT or HSCT) and GVHD.</jats:p></jats:sec><jats:sec id="ab-dbr230020-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>The main outcome was risk of vitiligo, assessed using multivariable Cox proportional hazards regression analyses adjusting for potential confounding factors.</jats:p></jats:sec><jats:sec id="ab-dbr230020-9"><jats:title>Results</jats:title><jats:p>The study included 23 829 patients who had undergone SOT or HSCT (62.78% male; mean [SD] age, 49.58 [11.59] years) and 119 145 age- and sex-matched controls. Patients who had undergone transplant had a significantly higher risk of vitiligo compared with controls (adjusted hazard ratio [AHR], 1.73; 95% CI, 1.35-2.22). Risk of vitiligo was also slightly higher in kidney transplant recipients and liver transplant recipients compared with the controls but was highest in HSCT recipients (AHR, 12.69; 95% CI, 5.11-31.50). Patients who had received allogeneic grafts (AHR, 14.43; 95% CI, 5.61-37.15), those who had received autologous grafts (AHR, 5.71; 95% CI, 1.20-3.18), those with comorbid GVHD (AHR, 24.09; 95% CI, 9.16-63.35), and those without GVHD (AHR, 8.21; 95% CI, 3.08-21.87) had a higher risk of vitiligo compared with controls.</jats:p></jats:sec><jats:sec id="ab-dbr230020-10"><jats:title>Conclusion and Relevance</jats:title><jats:p>In this study, risk of vitiligo was significantly higher in transplant recipients, especially in HSCT recipients and those with allogeneic grafts or comorbid GVHD. These findings provide new insights into the association between the risk of vitiligo and transplant and GVHD. Clinicians should be aware of these risks, implementing a multidisciplinary approach for monitoring.</jats:p></jats:sec>

Vitiligo-like depigmentation in patients with stage III-IV melanoma receiving immunotherapy and its association with survival: a systematic review and meta-analysis.

J Clin Oncol

Vitiligo following autologous hematopoietic stem cell transplantation.

Clin Lymphoma Myeloma Leuk

Vitiligo after hematopoietic cell transplantation: six cases and review of the literature.

Dermatology

Vitiligo following a combined liver-kidney transplant.

Nephrol Dial Transplant

Generalized vitiligo after allogeneic bone marrow transplantation.

Acta Derm Venereol

Subsequent vitiligo after hematopoietic stem cell transplantation: a nationwide population-based cohort study from Korea.

J Am Acad Dermatol

Decreased risk of vitiligo in organ transplant recipients: a population-based cohort study.

Increased risk for diabetes development in subjects with large variation in total cholesterol levels in 2,827,950 Koreans: a nationwide population-based study.

PLoS One

Bone marrow engraftment and associated dermatologic sequelae in a three-yr-old after liver transplantation.

Pediatr Transplant

Graft-versus-host disease after liver transplantation: a comprehensive literature review.

World J Gastroenterol

Graft-versus-host disease after solid organ transplantation: a single center experience and review of literature.

Ann Transplant

Adoptive transfer of vitiligo after allogeneic bone marrow transplantation for non-Hodgkin’s lymphoma.

Lancet

Transfer of vitiligo after allogeneic bone marrow transplantation.

Vitiligo following stem-cell transplant.

Bone Marrow Transplant

Vitiligo is a multifactorial, depigmenting skin disorder characterized by selective loss of melanocytes. Large-scale studies are lacking to determine the risk of vitiligo in transplant recipients with graft-vs-host disease (GVHD).
To investigate the incidence rates and risk of vitiligo in patients who had received solid organ transplant (SOT) or hematopoietic stem cell transplant (HSCT) overall and by HSCT graft type and concomitant GVHD.
This population-based cohort study included data from the National Health Insurance Service database of Korea for patients aged 20 years or older who had received a transplant (SOT or HSCT) between January 2010 and December 2017, with follow-up until December 2019. A cohort of age- and sex-matched (1:5) control individuals who did not receive a transplant was included for comparison. Data were analyzed from July 2021 to December 2021.
Transplant (SOT or HSCT) and GVHD.
The main outcome was risk of vitiligo, assessed using multivariable Cox proportional hazards regression analyses adjusting for potential confounding factors.
The study included 23 829 patients who had undergone SOT or HSCT (62.78% male; mean [SD] age, 49.58 [11.59] years) and 119 145 age- and sex-matched controls. Patients who had undergone transplant had a significantly higher risk of vitiligo compared with controls (adjusted hazard ratio [AHR], 1.73; 95% CI, 1.35-2.22). Risk of vitiligo was also slightly higher in kidney transplant recipients and liver transplant recipients compared with the controls but was highest in HSCT recipients (AHR, 12.69; 95% CI, 5.11-31.50). Patients who had received allogeneic grafts (AHR, 14.43; 95% CI, 5.61-37.15), those who had received autologous grafts (AHR, 5.71; 95% CI, 1.20-3.18), those with comorbid GVHD (AHR, 24.09; 95% CI, 9.16-63.35), and those without GVHD (AHR, 8.21; 95% CI, 3.08-21.87) had a higher risk of vitiligo compared with controls.
In this study, risk of vitiligo was significantly higher in transplant recipients, especially in HSCT recipients and those with allogeneic grafts or comorbid GVHD. These findings provide new insights into the association between the risk of vitiligo and transplant and GVHD. Clinicians should be aware of these risks, implementing a multidisciplinary approach for monitoring.

Risk of Subsequent Vitiligo in Transplant Recipients With Comorbid Graft-vs-Host Disease.

Risk of Subsequent Vitiligo in Transplant Recipients With Comorbid Graft-vs-Host Disease

Papers