Introduction One‐year post‐transplant survival is a significant quality measure for solid organ transplant programs in the United States. It is not known whether the use of this metric is associated with changes in life‐sustaining clinical practices that would delay mortality for solid organ recipients until just beyond the one‐year time point. Methods We compared trends in mortality in the time period immediately preceding the one‐year post‐transplant mark compared to the period immediately after using second‐order Cox proportional hazard regression models. Results Among recipients of heart, liver, and lung transplantation, mortality did not decrease significantly in the period immediately before day 365 or increase in the 14 days thereafter. There was an increased adjusted hazard of mortality in the 30 days following day 365 among lung transplant recipients (HR 1.33, 95% CI 1.03‐1.72, P = .03) with a 0.76% absolute mortality rate (94 deaths) in month 12 following lung transplantation and a 1.14% absolute mortality rate in month 13 (113 deaths). Conclusion Although we did not find evidence that life‐sustaining treatment is routinely continued until just beyond the one‐year mark in heart and liver transplantation recipients, there was an unexpected increased risk of mortality in the 30 days following day 365 among lung transplant recipients.

The epithelioid blue nevus (EBN) is a variant of the blue nevus characterized by heavily pigmented epithelioid melanocytes and lightly or nonpigmented spindle cells. It may be associated with Carney complex, a multiple neoplasia syndrome. Congenital cases of EBN not associated with Carney complex are rarely reported. We herein describe an infant who presented with multiple blue‐gray nodules and papules involving the head, trunk, and extremities at birth, the corresponding histopathologic findings, and genetic testing results.

Prior studies examining racial disparities in melanoma presentation have found that African-American (AA) patients generally present at a later stage at diagnosis, have a worse overall survival, greater Breslow depth, and greater Clark level compared to white patients. However, prior studies have not controlled for histologic subtype, namely that acral lentiginous melanomas (ALM) are the most frequent subtype observed in AA patients and superficial spreading melanoma (SSM) the most common subtype in Caucasian patients. Previous reports have shown that ALM confers a worse prognosis and greater Breslow depth at diagnosis than SSM. To address this shortcoming, we performed a retrospective case-control study of melanoma patients seen at the University of Pennsylvania Health System from 1986 to 2016. We compared the paired differences of three histologic prognostic factors, Breslow depth, Clark level, and mitotic rate, for each AA case patient (n¼52) with four matched non-Hispanic white (N-HW) control patients diagnosed with the same histologic subtype of melanoma. Because of concerns that differences in the characteristics of interest may be reflections of differences in physicians' diagnostic ability over time, matched N-HW cases had to be diagnosed within a ten-year period of the date of diagnosis of the AA patient. We found that AA patients had a significantly greater Breslow depth (mean 2.7 vs 0.76, p < 0.0001), higher mitotic rate (mean 4.4 vs 0.64, p < 0.0001), and had a significantly different distribution of Clark level (p < 0.001) compared with matched N-HW controls. These results show that differences in several important tumor characteristics exist between African American and non-Hispanic white patients, highlighting an important racial disparity that may have significant public health implications for the African American population.