Thinking about Transplants: The Risk of Vitiligo in Transplant Recipients

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

What are the key takeaways of this article?

Vitiligo is a multi factorial and depigmenting skin disorder associated with selective loss of melanocytes. Recently, de novo vitiligo associated with immune disturbances has been reported. Although some studies have proposed that there is an association between vitiligo and transplant, there is limited evidence on this association outside of case reports. In this population-based cohort study conducted by Bang et al., the authors investigated the incidence rates and risk of vitiligo in patients who received a solid organ transplant or hematopoietic stem cell transplant. In particular, they distinguished risk by hematopoietic stem cell transplant graft type and concomitant graft-vs-host disease.

This study included 23,829 patients aged 20 or older who had undergone either solid organ or hematopoietic transplant and 119,145 age- and sex-matched controls. Interestingly, the risk of vitiligo was found to be higher in the overall transplant group with an adjusted hazard ratio (AHR) of 1.73. Both the kidney and liver transplant groups also displayed a higher risk of vitiligo compared to controls (AHR of 1.50 and 1.63, respectively), though patients who had undergone a hematopoietic stem cell transplant had the highest risk compared to controls with an adjusted hazard ratio of 12.69. Specifically, patients with allogeneic hematopoietic stem cell transplant (AHR 14.43), those who received autologous grafts (AHR 5.71), those with comorbid graft-vs-host disease (AHR 24.09), and even those without graft-vs-host disease (AHR 8.21) all had a significantly higher risk of vitiligo compared to the control group.

While the exact nature of the association between transplant and vitiligo risk remains to be elucidated, the authors of this study propose several hypotheses, such as an adoptive passive transfer of melanocyte autoantibodies from donor to recipient or that chronic graft-vs-host disease may induce an immune response selective to melanocyte destruction.

In summary, this study found that the risk of vitiligo was significantly higher in patients who had undergone hematopoietic stem cell transplant and in those with comorbid graft-vs-host disease. Consequently, patients undergoing transplant should be monitored for the development of vitiligo based on its likelihood of developing in this patient population.

Publication Date: January 28th, 2024

Reference: Bang CH, Park HE, Kim YH, et al. Risk of Subsequent Vitiligo in Transplant Recipients With Comorbid Graft-vs-Host Disease. JAMA Dermatol. Published online December 13, 2023. doi:10.1001/jamadermatol.2023.4933

Summary By: Taylor Skinner