De Novo neoplasia after liver transplantation: An analysis of risk factors and influence on survival

Abstract

Immunosuppression increases the risk of posttransplant malignancy and it may increase posttransplant mortality. The finding of factors related to the development of posttransplant malignancy may serve as a guide to avoid those risk factors and to develop strategies of posttransplant surveillance. The incidence and risk factors of malignancy were studied in 187 consecutive liver transplant recipients surviving more than 3 months. None of the 12 patients surviving less than 3 months had de novo neoplasia. The impact of malignancy on survival was studied in a casecontrol study. After a median follow-up of 65 months, 49 patients developed 63 malignancies: 25 patients had 35 cutaneous neoplasias and 27 patients had 28 noncutaneous malignancies. The 5-and 10-year actuarial rates of cutaneous neoplasia were 14 and 24% and the rates of noncutaneous neoplasia were 11 and 22%, respectively. Risk factors for the development of cutaneous malignancy were older age and Child-Turcotte-Pugh A status. Risk factors for the development of noncutaneous malignancy were older age, alcoholism, and smoking. Cutaneous neoplasia had no effect on survival, whereas patients with noncutaneous malignancy had a significant reduction of survival. The overall relative risk of cutaneous and noncutaneous neoplasia, as compared with the general population were 16.91 (95% confidence interval: 11.78-23.51) and 3.23 (95% confidence interval: 2.15-4.67), respectively. The relative risk of cancer-related mortality (after excluding recurrent malignancy) was 2.93 (95% confidence interval: 1.56-5.02). Multivariate analysis showed that noncutaneous malignancy was an independent risk factor for posttransplant mortality. In conclusion, liver transplant recipients have a higher risk of cancer-related mortality than the general population. This increased risk is due to the development of noncutaneous neoplasia. Older age, alcoholism, and smoking increase the risk of de novo noncutaneous neoplasia. (Liver Transpl 2005;11: 89-97.)

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

“…Differences in latitude and sun exposure and immunosuppressive protocols may explain these differences. We found no mortality in these patients, thus confirming the low mortality observed by other authors [9,17,23,24]. In our outpatient clinic, dermatological evaluations are made in all patients so that these lesions can be diagnosed and treated.…”

“…In fact, when survival was compared between patients with skin and non-skin tumors, differences were evident. It has been well described that patients who develop DN have shorter survival post-LT [23] and that the DN represents a major cause of late mortality following DN, as recently published by our group [6]. Although a case-control analysis to assess this fact was not made in the present study, shorter survival after DN was observed in patients developing non-skin tumors.…”

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

“…12 Currently, long-term graft loss and death are not commonly related to rejection but are often due to age-related complications, such as cardiovascular disease and de novo cancers. 13,14 The rate of de novo cancers after LTx has been reported to range from 3% to 26%, [15][16][17][18] and the variation is partly due to the length of follow-up, different ways of reporting, and geographic variations in de novo malignancies. Although registry data of de novo cancers provide a valuable source for accounting for the various types of malignancies; these registries do not include the denominator of the population at risk.…”

“…Herrero et al 16 reviewed 187 cases and found 63 malignancies (lymphoid lesions included). On a univariate analysis, for they found age to be a significant risk factor for de novo cancers (P ϭ 0.01).…”

Administration of anti-neoplastic agents to treat malignancies in solid organ transplant recipients

“…The incidence of malignancies in the post-SOT setting could not be estimated from our study as our patients were identified from a pool of cancer patients rather than transplant patients. Many reports have estimated the incidence to range between 2.6% and 26% [8,9] . Cancer can develop as early as 22 months into post-SOT but may also take up to 10 years to be detected [7] .…”