De Novo Internal Neoplasms after Liver Transplantation: Increased Risk and Aggressive Behavior in Recent Years?

Abstract

The goal of the study was to determine the incidence and variables associated with post-liver transplantation (LT) de novo internal neoplasms development, excluding skin tumors and hepatocellular carcinoma. Medical records were reviewed for recipient/donor demographics, viral serology, cause of liver disease, interval from LT to tumor diagnosis, predisposing factors, immunosuppression and survival. Forty-one neoplasms (31 solid and 10 hematologic) developed in 772 recipients (5.3%) transplanted between 1991 and 2001. Time to tumor diagnosis was longer in patients transplanted before 1995 than in those transplanted afterwards (58 vs. 22 months; p < < 0.05). Hematologic neoplasms (HN) appeared earlier than solid (2 vs. 21 months; p < < 0.001), were more prevalent in those transplanted after 1995 than before (32% vs. 12.5%), and had lower survival than solid (2 vs. 21 months, p < < 0.001). While HCV was the most frequent indication in HN (70%), alcohol was that of solid tumors (71%). Overall, risk factors for de novo neoplasms included alcohol and immunosuppression (p < < 0.01). In patients undergoing LT in recent years, there is a higher incidence of HN with de novo internal neoplasms developing at earlier time-points than in those transplanted years ago. Risk factors for tumor development include alcohol, HCV and possibly strong immunosuppression.

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].…”

“…Patients who receive surgical treatment for DN have better survival; thus, in our opinion, we must be surgically aggressive whenever possible. When survival after DN was analyzed, we found 5-year survival of 55%, which is probably higher than that described by other groups [15,31] and may be due to the high percentage of patients developing skin tumors with nil mortality. In fact, when survival was compared between patients with skin and non-skin tumors, differences were evident.…”

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. Nonmelanoma, non-Kaposi's skin cancers (squamous cell cancer and basal cell carcinoma) are the commonest types of de novo malignancies in the posttransplant population, with an up to 70 times higher incidence in comparison with nontransplant populations.…”

Case Report: Bone Tumor of the Scapula in a Patient Undergoing Liver Transplantation

“…immunocompetent individuals. One retrospective study suggested a dose-dependent relationship of immunosuppressive agents to the occurrence of de novo malignancy [2]. Direct carcinogenic effect of immunosuppressive medications and cyclosporine-induced cancer cell progression also has been suggested [5].…”

“…The probabilities of a de novo neoplasm increase from 13% at 5 years to 26% at 8 years after liver transplantation [18], a percentage that is higher than that in a healthy age-matched population [2,4,12]. The common de novo tumors were skin malignancies, posttransplantation lymphoproliferative disorder, tumors of the head and neck, and Kaposi's sarcoma.…”