Gender, Race and Disease Etiology Predict De Novo Malignancy Risk After Liver Transplantation: Insights for Future Individualized Cancer Screening Guidance

Bhat, Mamatha; Mara, Kristin C.; Dierkhising, Ross A.; Watt, Kymberly D.

doi:10.1097/tp.0000000000002113

Cited by 33 publications

(41 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The largest study showed a 1.6-fold excess risk of any cancer, and a similar site-specific cancer risk profile to that observed for all people living with a transplanted liver [14] . Non-population based evidence from South Korean patients transplanted for HCC has also generated a similar cancer profile to that described above, as well as an excess risk of leukemia, myeloma, and thyroid cancer [27] . Interestingly, this study found a substantially higher short-compared to long-term risk of cancer, with most cancers diagnosed within the first 12 months of transplantation.…”

Section: Cancer Riskmentioning

confidence: 66%

Extrahepatic cancer risk after liver transplantation for hepatocellular carcinoma: incidence, risk and prevention

Vajdic¹,

Leeuwen²,

McCaughan³

2021

View full text Add to dashboard Cite

This article synthesises the current evidence on the risk of de novo extrahepatic cancer in people living with a liver transplant after hepatocellular carcinoma, the risk factors for cancer, and the recommended approaches to cancer prevention and surveillance. People living with a transplanted liver have an elevated risk of cancer and cancer death, and the indication for transplantation does not markedly alter the cancer risk. The excess risk of cancer is double that of the age-and sex-matched general population. Virus-related cancers, especially non-Hodgkin lymphoma, Kaposi sarcoma, Merkel cell carcinoma, oral, and anogenital cancers occur at increased risk, as do cancers causally associated with high prior sun exposure, smoking and excessive alcohol consumption, including skin, oesophageal, larynx, lung, kidney, and bladder cancer. The risk of incident breast and prostate cancer is not increased. Cancer-related deaths largely mirror that for cancer incidence, and extend to include the more common malignancies such as breast, colorectal, prostate cancer and non-melanoma skin cancer. As medical immunosuppression is the principal risk factor for cancer, the regimen should be reviewed on a regular basis to achieve immunosuppression minimisation. An individual, risk-based approach to cancer screening according to test characteristics and personal and family cancer history, medical history, lifestyle factors, and life expectancy is recommended. Multicomponent interventions may achieve the best results in supporting the adoption and maintenance of cancer risk-reducing behaviours. Regular, empowering patient counselling and education is a cornerstone for the care of people living with a liver transplant.

show abstract

Section: Cancer Riskmentioning

confidence: 66%

Extrahepatic cancer risk after liver transplantation for hepatocellular carcinoma: incidence, risk and prevention

Vajdic¹,

Leeuwen²,

McCaughan³

2021

View full text Add to dashboard Cite

show abstract

“…The probabilities of de novo malignancies post‐LT were higher than those in the age‐matched general population 27 . The screening of de novo malignancies has been reportedly recommended post‐LT 28 . A previous study also revealed the higher mortality rate of de novo malignancy post‐transplant despite the likelihood of earlier cancer detection with careful monitoring along with post‐transplant follow‐up/surveillance.…”

Section: Discussionmentioning

confidence: 97%

De novo hepatocellular carcinoma in living donor liver grafts: A Japanese multicenter experience

Goto

Kosai‐Fujimoto

Yagi

et al. 2020

Hepatology Research

View full text Add to dashboard Cite

Direct-acting antivirals for hepatitis C virus have reduced the decompensation risk. Immunosuppressants for transplantation raise the risk of occurrence of de novo malignancies. We assessed the probabilities of and risk factors for de novo hepatocellular carcinoma (HCC) development post-living donor liver transplantation (LDLT). Methods: We retrospectively evaluated the data of developed HCC in a graft including metastatic HCC post-LDLT from 2779 adult cases collected from nine major liver transplantation centers in Japan. Results: Of 2779 LDLT adult recipients, 34 (1.2%) developed HCCs in their grafts. Of 34, five HCCs appeared to be de novo because of a longer period to tumor detection (9.7 [6.4-15.4] years) and no HCC within the native liver of the two recipients. The donor origin of three of five de novo HCCs was confirmed using microsatellite analysis in resected tissue. Primary disease of all five was hepatitis C virus-related cirrhosis, of which two were treated with direct-acting antivirals. Four of five developed HCC de novo in the hepatitis B core antibody-positive grafts. De novo HCCs had favorable prognosis; four of five were cured with complete remission. However, recurrent HCC (n=29) in the graft had a poorer outcome, especially in patients with neutrophil to lymphocyte ratio scores above 4 (median survival time, 262 [19-463] days). Conclusion: Analysis of the database from major liver transplantation institutes in Japan revealed that de novo HCCs determined by microsatellite analysis were rarely detected, but the majority were successfully treated. LDLT recipients with higher

show abstract

“…In post‐LT patients, increasing age, prior malignancies, and multi‐organ transplant have shown to be associated with increased risk . More specifically, male gender, obesity, and diabetes have been shown to be associated with increased risk of solid organ tumors after liver transplant .…”

Section: Discussionmentioning

confidence: 99%

“…17,44,45 More specifically, male gender, obesity, and diabetes have been shown to be associated with increased risk of solid organ tumors after liver transplant. 17,44,45 Pertinent to this case, though the risk of colorectal carcinoma in patients on prolonged immunosuppression was initially felt to be similar to that of the general population, more recent studies have reported up to a twofold increased risk with significantly worse prognosis and outcomes. 16,44,45 Given Rachel Phelan https://orcid.org/0000-0001-5252-9991…”

Section: Discussionmentioning

confidence: 99%

Sequential transplantation and implications for clinical management: OLT followed by HCT and consequent RT in a pediatric patient

Hoogenboom

Margolis

Anderson

et al. 2019

Pediatric Transplantation

View full text Add to dashboard Cite

We report a case of a pediatric patient who required three separate transplants: OLT at the age 5, HCT at age 13 (8 years post‐OLT), and cadaveric RT at age 15 (10 years post‐OLT). The child initially presented with fulminant liver failure without known cause, ultimately undergoing OLT from his mother. He then developed SAA, for which he required HCT. Unfortunately, he developed ESRD secondary to prolonged CNI exposure, for which he underwent cadaveric RT. These processes then resulted in 7 years largely free from complications, during which a multi‐disciplinary team monitored the patient for complications. Regrettably, at the age of 21 he developed poorly differentiated mucinous adenocarcinoma of the colon which ultimately led to his demise. While there are case reports of patients requiring two sequential transplants, there is a paucity of reports of successfully completing three separate organ transplants in the same patient. Our case demonstrates progression of a pediatric patient through OLT, HCT, and RT with discussion of notable clinical implications. Secondarily, this case highlights the importance of coordination of care amongst various subspecialties to facilitate tandem transplantations and manage the complications of these processes. As pediatric patients have improved survival rates and may require multiple transplants, it remains important to highlight the feasibility as well as the complications of the tandem transplant process.

show abstract

Gender, Race and Disease Etiology Predict De Novo Malignancy Risk After Liver Transplantation: Insights for Future Individualized Cancer Screening Guidance

Abstract: This large dataset demonstrates the effects of ethnicity/race and etiologies of liver disease, particularly NASH as additional risk factors for cancer after LT. Patients with these high-risk characteristics should be more regularly and diligently screened.

Cited by 33 publications

References 30 publications

Extrahepatic cancer risk after liver transplantation for hepatocellular carcinoma: incidence, risk and prevention

Extrahepatic cancer risk after liver transplantation for hepatocellular carcinoma: incidence, risk and prevention

De novo hepatocellular carcinoma in living donor liver grafts: A Japanese multicenter experience

Sequential transplantation and implications for clinical management: OLT followed by HCT and consequent RT in a pediatric patient

Contact Info

Product

Resources

About