BACKGROUND: The proportion of Merkel cell carcinomas (MCCs) in solid-organ transplant recipients (SOTR) harbouring Merkel cell polyomavirus (MCPyV) is unknown, as are factors affecting their outcomes. OBJECTIVE: To describe clinicopathological features of MCC in SOTR, investigate the tumoral MCPyV-status and identify factors associated with tumour outcomes. METHODS: Retrospective, international, cohort-study. MCPyV-status was investigated by immunohistochemistry and polymerase chain reaction. RESULTS: A total of 30 SOTR and 44 consecutive immunocompetent patients with MCC were enrolled. SOTR were younger at diagnosis (69 vs. 78 years, P < 0.001). Thirty-three percent of SOTR MCCs were MCPyV-positive vs. 91% of immunocompetent MCCs (P = 0.001). Solid-organ transplantation was associated with an increased cumulative incidence of progression (SHR: 3.35 [1.57-7.14], P = 0.002), MCC-specific mortality (SHR: 2.55 [1.07-6.06], P = 0.034) and overall mortality (HR: 3.26 [1.54-6.9], P = 0.002). MCPyV-positivity and switching to an mTOR inhibitor (mTORi) after MCC diagnosis were associated with an increased incidence of progression (SHR: 4.3 [1.5-13], P = 0.008 and SHR: 3.6 [1.1-12], P = 0.032 respectively) in SOTR. LIMITATIONS: Retrospective design and heterogeneity of SOTR cohort. CONCLUSIONS: MCPyV appears to play a less prominent role in the aetiopathogenesis of MCC in SOTR. SOTR have a worse prognosis than their immunocompetent counterparts and switching to an mTORi after the diagnosis of MCC does not improve progression.

Centre for Cell Biology and Cutaneous Research Blizard Institute Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK

Department of Dermatology Başkent University Faculty of Medicine Ankara Turkey

Department of Dermatology Edouard Herriot Hospital Group Hospices Civils de Lyon Lyon France

Department of Dermatology Fundación Jiménez Díaz Madrid Spain

Department of Dermatology Hospital de Bellvitge IDIBELL University of Barcelona Barcelona Spain

Department of Dermatology Hospital Universitari Mútua de Terrassa Barcelona Spain

Department of Dermatology Hospital Universitari Vall d'Hebron Universitat Autònoma de Barcelona Barcelona Spain

Department of Dermatology Istanbul University Istanbul Medical Faculty Istanbul Turkey

Department of Dermatology Leiden University Medical Center Leiden The Netherlands

Department of Dermatology Medical University of Vienna Vienna Austria

Department of Dermatology University Clinic of Navarra School of Medicine University of Navarra Pamplona Spain

Department of Dermatology University of Groningen University Medical Center Groningen Groningen The Netherlands

Department of Dermatology University of São Paulo São Paul Brazil

Department of Dermatovenereology Faculty of Medicine Charles University Pilsen The Czech Republic

Department of Pathology School of Medicine Catholic University of Valencia 'San Vicente Martir' Valencia Spain

Dermatology Unit Department of Medicine Università di Padova Padova Italy

Dermatopathologie Friedrichshafen Germany

IVO CIPF Joint Research Unit of Cancer Príncipe Felipe Research Center Valencia Spain

Kempf und Pfaltz Histologische Diagnostik and Department of Dermatology University Hospital Zurich Zürich Switzerland

Laboratory of Molecular Biology Fundación Instituto Valenciano de Oncología Valencia Spain

Service de Dermatologie Hôpital Erasme Université Libre de Bruxelles Brussels Belgium

Servicio de Dermatología Instituto Valenciano de Oncología Valencia Spain

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