De novo malignancies after liver transplantation using tacrolimus-based protocols or cyclosporine-based quadruple immunosuppression with an interleukin-2 receptor antibody or antithymocyte globulin

Abstract

months) for all patients. Conventional triple therapy was implemented in 25 patients, CsA-based quadruple induction therapy using an antilymphocyte globulin 1 Department of Surgery and Transplantation preparation (ATG) in 190 patients, an interleukin-2 receptor antibody (BT563) in Medicine, Virchow Medical Center, Humboldt 141 patients, and tacrolimus-based dual or triple immunosuppression in 102 paUniversity Berlin, Berlin, Germany.tients. The different protocols were evaluated in four randomized and two nonran-2 Department of Hematology/Oncology, Virchow domized prospective trials. Medical Center, Humboldt University Berlin, RESULTS.De novo neoplasias were detected in 33 patients (7.2%) and were comBerlin, Germany.prised of lymphomas (n Å 7), skin malignancies (n Å 8 lesions in 7 patients), intraepithelial neoplasias of the cervix uteri (n Å 7), breast carcinoma (n Å 3), lung carcinoma (n Å 3), and other malignancies (n Å 6). The incidence of de novo neoplasias did not differ in the different trial arms. Only a positive T-crossmatch and a low CD4 / /CD8 / ratio in patients receiving CsA-based immunosuppression demonstrated a significant correlation with the development of a de novo tumor in a multivariant logistic regression analysis. CONCLUSIONS. The development of de novo neoplastic diseases after liver trans-plantation with the use of CsA-based quadruple induction protocols or tacrolimusbased regimens for immunosuppresion was assessed over the long term. Recently introduced immunosuppressive protocols did not alter the posttransplant de novo tumor rate. Patients with a low CD4 / /CD8 / ratio during CsA-based therapy or a positive T-crossmatch were identified to be at an increased risk for the development of a de novo malignancy.

Evolution and management of de novo neoplasm post-liver transplantation: a 20-year experience from a single European centre

“…The first studies reported an incidence of 3-5% [10][11][12]; however, this has appeared to be higher, up to 22% [7]. In our experience, the incidence of DN post-LT was 9.5%, higher than the tumor incidence described in the general population by age groups [13], but similar to that reported in previous studies on LT recipients [14][15][16][17].…”

Incidence of de novo cancer and lymphoproliferative disorders after liver transplantation in relation to age and duration of follow-up

“…For example, some authors prefer to include posttransplant lymphoproliferative disorders (PTLDs) along with de novo solid cancers, [22][23][24][25][26][27][28][29][30] whereas others prefer not to include them. 15,18,31,32 This has caused a major discrepancy in reported rates of de novo cancers.…”

“…However, the incidence does not appear to be higher in the post-LTx population. 17,18,22,23,26,32,33 Haagsma and coworkers 24 from the Netherlands reported a 30-fold increase in de novo cancers of the kidney. Also, in a large Swedish post-kidney and liver transplant population study of 5931 cases, SIR for kidney cancer was 4.9 times higher.…”

“…Jonas et al 26 reported a high incidence of cervical intraepithelial neoplasia in patients post-LTx using quadruple therapy.…”

Tacrolimus ointment vs steroid ointment for eyelid dermatitis in patients with atopic keratoconjunctivitis

“…A serious safety signal of malignant tumour appearance has emerged for systemic tacrolimus treatment, 30 but concerning topical administration, several studies have demonstrated only a minimal absorption of the drug. 12,17,19 However, carcinogenesis at the application site has been shown in a mouse model.…”