Prospective Registry‐Based Observational Cohort Study of the Long‐Term Risk of Malignancies in Renal Transplant Patients Treated with Mycophenolate Mofetil

Robson, Richard; Cecka, J. Michael; Opelz, Gerhard; Budde, M.; Sacks, Susan T.

doi:10.1111/j.1600-6143.2005.01125.x

Cited by 225 publications

(149 citation statements)

References 16 publications

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“…Long term use of azathioprine increases the risk of non-melanoma skin cancer [111] and lymphoma, the later when high doses are used especially in elderly patients [112] , but there is no proved role on HCC. On the other hand mycophenolate seems to be protective against malignancy in the transplant population [113,114] but again there is no evidence supporting any significant effect on HCC. With regard to induction agents, the anti-interleukin-2 receptor basiliximab does not increase the risk of cancer, but anti-thymocyte globulins have been associated with an increased risk of lymphoma [115] .…”

Section: Strategies To Improve Outcome After Liver Transplantationmentioning

confidence: 95%

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Guerrero-Misas

Rodríguez‐Perálvarez

Mata

2015

WJH

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Liver transplantation is the only therapeutic option which allows to treat both, the hepatocellular carcinoma and the underlying liver disease. Indeed, liver transplantation is considered the standard of care for a subset of patients with cirrhosis and hepatocellular carcinoma.However, tumour recurrence rates are as high as 20%, and once the recurrence is established the therapeutic options are scarce and with little impact on prognosis. Strategies to minimize tumour recurrence and thus to improve outcome may be classified into 3 groups: (1) An adequate selection of candidates for liver transplantation by using the Milan criteria; (2) An optimized management within waiting list including prioritization of patients at high risk of tumour progression, and the implementation of bridging therapies, particularly when the expected length within the waiting list is longer than 6 mo; and (3) Tailored immunosuppression comprising reduced exposure to calcineurin inhibitors, particularly early after liver transplantation, and the addition of mammalian target of rapamycin inhibitors. In the present manuscript the available scientific evidence supporting these strategies is comprehensively reviewed, and future directions are provided for novel research approaches, which may contribute to the final target: to cure more patients with hepatocellular carcinoma and with an improved long term outcome. Core tip: Liver transplantation is the only therapeutic option which allows to treat both, the hepatocellular carcinoma and the underlying liver disease. However, tumour recurrence rates are 15%-20% with a very poor prognosis. Strategies to minimize tumour recurrence and thus to improve outcome are focused in a careful selection of candidates for liver transplantation, an optimized management within waiting list and a tailored immunosuppression. The available scientific evidence supporting these strategies is reviewed, and future directions are provided for novel research approaches, which may contribute to the final target: to cure more REVIEW Submit a

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Section: Strategies To Improve Outcome After Liver Transplantationmentioning

confidence: 95%

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Guerrero-Misas

Rodríguez‐Perálvarez

Mata

2015

WJH

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“…Dividing the dose to a four times a day schedule may be helpful; however, more serious adverse GI effects as inflammatory bowel disease-like colitis and graft vs host disease-like enteropathy related to MPA have been reported [61,62] . MPA seems to have a protective effect against post transplant de novo malignancies and when included in immunosuppression regimens may increase the time to develop malignancies [63] , however, MPA was not shown to be effective in prevention of post liver transplant recurrence of HCC [64] .…”

Section: Maintenance Immunosuppressionmentioning

confidence: 99%

Review on immunosuppression in liver transplantation

Moini

Schilsky

Tichy

2015

WJH

200

159

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“…Recipients of older-aged donations (older than 65 y), with exposure to calcineurin inhibitors and previous use of thymoglobulin, are at greater risk. 19 This patient's presentation of a high-grade sarcoma was atypical. It is common for a surgeon to excise a mass found by a patient on self-examination only to find out after the pathology report returns that the mass was malignant.…”

Section: Discussionmentioning

confidence: 99%

Soft Tissue Sarcoma at a Dialysis Access Site in a Transplant Recipient

Andre¹,

Parsikia²,

Minimo³

et al. 2012

Exp Clin Transplant

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Soft tissue sarcomas typically present as soft, painless masses on an extremity. Here, we present a patient with metastatic soft tissue sarcomas at his dialysis access site. This association with dialysis access has not been documented previously.A 62-year-old man presented with a nonhealing wound on his left upper extremity after excision of a pseudoaneurysmal arteriovenous fistula. The patient had received a second kidney transplant that was functioning well. Immunosuppression included tacrolimus, mycophenolate mofetil, and prednisone. He was induced with thymoglobulin twice.A biopsy was performed showing a high-grade pleomorphic sarcoma. A magnetic resonance image of his left upper extremity showed an 11 × 5.5 × 3 cm mass abutting the biceps and brachialis muscles. Also, we discovered several lesions in the axilla and the left side of the neck, which were suspicious for metastases. A positron emission tomographycomputed tomography scan confirmed a left upper extremity soft tissue mass, with marked fluorodeoxyglucose uptake, in abnormally enlarged axillary, and supraclavicular lymph nodes of the left thorax, consistent with metastases. The patient underwent chemotherapy and radiation therapy.Soft tissue sarcomas are rare. A high index of suspicion is needed to make a diagnosis. This is the first reported case of a soft tissue sarcoma discovered at a dialysis access site. As with all malignancies, early diagnosis is key to patient survival. Thorough physical examinations and increased vigilance by physicians caring for immunosuppressed patients is invaluable.

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Prospective Registry‐Based Observational Cohort Study of the Long‐Term Risk of Malignancies in Renal Transplant Patients Treated with Mycophenolate Mofetil

Cited by 225 publications

References 16 publications

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Strategies to improve outcome of patients with hepatocellular carcinoma receiving a liver transplantation

Review on immunosuppression in liver transplantation

Soft Tissue Sarcoma at a Dialysis Access Site in a Transplant Recipient

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