Chul Hwan Bang, MD, PhD

Credit: The Catholic University of Korea Seoul

Vitiligo risk is shown to be greater among organ transplant recipients, according to new findings, and especially among hematopoietic stem cell transplant (HSCT) recipients and patients with allogeneic grafts or comorbid graft-vs-host disease (GVHD).¹

These results came from an analysis conducted due to the lack of data quantifying risk of vitiligo according to comorbid GVHD. There had previously been studies in a similar vein which were population-based, though these primarily assessed the link between vitiligo and transplants.²

This new research into GVHD and vitiligo risk was led by Chul Hwan Bang, MD, PhD, from Seoul St Mary’s Hospital Department of Dermatology at the The Catholic University of Korea College of Medicine in Seoul, Korea.

“To our knowledge, no large-scale studies have quantified the risk of vitiligo according to comorbid graft-vs-host disease (GVHD),” Bang and colleagues wrote. “We analyzed the risk of subsequent vitiligo in patients who had received SOT or HSCT based on the National Health Insurance Service (NHIS) claims database.”

Background and Findings

The investigators used a cohort study design in which they drew from the NHIS database, known to cover more than 97% of the South Korean population. The research team’s analysis aimed at participants aged 20 years or older who had been given a transplantation in the period between January 2010 - December 2017.

The team excluded from their work subjects who had prior diagnoses of vitiligo and they utilized a 12-month lag period. The overall cohort was made up of recipients of HSCTs, transplants of solid organs such as kidney and liver, and age- and sex-matched controls with a ratio of 1:5 ratio.

Subjects participating in the research were monitored for up to a decade, from January 2010 - December 2019, in order for the research team to point out cases of new-onset vitiligo.

Regarding subjects that had health checkup data, the investigators used a supplementary analysis that they implemented through the use of the NHIS health checkup database. The database stores data on patients’ lifestyles on topics such as fasting blood glucose, smoking status, BMI, physical activity, consumption of alcohol, blood pressure, and levels of cholesterol.

The research team defined the participants’ comorbidities through the use of ICD-10 codes, with their analysis from July - December 2021 involving multivariable Cox proportional hazards regression helping to assess subjects’ risk of vitiligo risk.

The team made the necessary adjustments for factors like sex, age, hypertension, dyslipidemia, diabetes, and previous cases of hematologic disorders. Their search of the database further looked at elements such as consumption of alcohol, total cholesterol, BMI, physical activity, fasting plasma glucose, and patients’ systolic blood pressure.

Overall, the investigators ended up looking at the data of 23,829 subjects who had been given a solid organ transplant (SOT) or a hematopoietic stem cell transplant (HSCT). They also used 119,145 individuals for their age- and sex-matched control arm, with 62.78% being male and a mean age of 49.58 years.

The research team reported that those who had been given transplants, especially those in the HSCT recipient category of subjects, were shown to have had a much more elevated risk of vitiligo versus those in the control arm (adjusted hazard ratio [AHR], 1.73; 95% CI, 1.35-2.22).

Recipients of kidneys and livers as transplants also were shown by the team to have exhibited a slightly greater level of risk. The investigators noted that those labeled as HSCT recipients were shown to have had the highest risk of developing vitiligo (AHR, 12.69; 95% CI, 5.11-31.50).

Additionally, those that had comorbid GVHD (AHR, 24.09; 95% CI, 9.16-63.35), those who received allogeneic grafts (AHR, 14.43; 95% CI, 5.61-37.15), those who received autologous grafts (AHR, 5.71; 95% CI, 1.20-3.18), and those that did not have GVHD (AHR, 8.21; 95% CI, 3.08-21.87) were shown by the team to have greater risk of developing vitiligo versus those in the control arm.

“Our study benefits from a nationally representative, large study population,” they wrote. “In particular, because transplant recipients are covered by the Individual Copayment Beneficiaries Program for rare and intractable disorders, diagnosis is relatively reliable.”

References

1. ^{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.}
2. ^{Bae JM, Choi KH, Jung HM, et al. Subsequent vitiligo after hematopoietic stem cell transplantation: a nationwide population-based cohort study from Korea. J Am Acad Dermatol. 2017;76(3):459-463. doi:10.1016/j.jaad.2016.08.064.}