<i>De novo</i> malignancies after liver transplantation: The effect of immunosuppressionn-personal data and review of literature

Manzia, Tommaso Maria; Angelico, Roberta; Gazia, Carlo; Lenci, Ilaria; Mihalj, Martina; Ademoyero, Oludamilola T; Pedini, Domiziana; Toti, Luca; Spada, Marco; Tisone, Giuseppe; Baiocchi, Leonardo

doi:10.3748/wjg.v25.i35.5356

Cited by 56 publications

(52 citation statements)

References 156 publications

(166 reference statements)

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“…Data from patients undergoing LT for HCC underscore the crucial role of immunosuppression type in patients’ outcomes by reducing the risk of HCC recurrence [ 145 ]. Moreover, in post-orthotopic LT, the incidence of de novo malignancies is 2–4 times higher than in the general population, with lymphoproliferative disorders and skin cancers being the most frequent ones [ 146 ].…”

Section: How We Treat Aild Patients With Hccmentioning

confidence: 99%

Current Trends and Characteristics of Hepatocellular Carcinoma in Patients with Autoimmune Liver Diseases

Rigopoulou

Dalekos

2021

Cancers

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Hepatocellular carcinoma (HCC), the commonest among liver cancers, is one of the leading causes of mortality among malignancies worldwide. Several reports demonstrate autoimmune liver diseases (AILDs), including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) to confer increased risk of hepatobiliary malignancies, albeit at lower frequencies compared to other liver diseases. Several parameters have been recognized as risk factors for HCC development in AIH and PBC, including demographics such as older age and male sex, clinical features, the most decisive being cirrhosis and other co-existing factors, such as alcohol consumption. Moreover, biochemical activity and treatment response have been increasingly recognized as prognostic factors for HCC development in AIH and PBC. As available treatment modalities are effective only when HCC diagnosis is established early, surveillance has been proven essential for HCC prognosis. Considering that the risk for HCC is not uniform between and within disease groups, refinement of screening strategies according to prevailing demographic, clinical, and molecular risk factors is mandated in AILDs patients, as personalized HCC risk prediction will offer significant advantage in patients at high and/or medium risk. Furthermore, future investigations should draw attention to whether modification of immunosuppression could benefit AIH patients after HCC diagnosis.

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Section: How We Treat Aild Patients With Hccmentioning

confidence: 99%

Current Trends and Characteristics of Hepatocellular Carcinoma in Patients with Autoimmune Liver Diseases

Rigopoulou

Dalekos

2021

Cancers

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“…Few studies have assessed the relationship between skin cancer risk and multidrug immunosuppression, although most OTR were treated with combinations of immunosuppressive drugs 19,22–26 . The present study found that treatment with three or more immunosuppressive drugs significantly increased the risk of developing new skin cancers.…”

Section: Discussionmentioning

confidence: 48%

Twenty‐eight‐year incidence and characteristics of post‐transplant skin cancers: Comparative analysis of past and recent 10‐year experience

Kim¹,

Jung²,

Park

et al. 2020

The Journal of Dermatology

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Because primary skin cancers in organ transplant recipients are rare, little is known about the characteristics and risk factors for skin cancers in organ transplant recipients. We searched the Asan Medical Center database of 13 469 organ transplant recipients for cases of all skin cancers from January 1990 to December 2018. Characteristics of and risk factors for skin cancers were analyzed and compared according to the period of transplantation. Of the identified 113 patients with skin cancers, squamous cell carcinoma was the most common cancer followed by basal cell carcinoma and Kaposi sarcoma. The cumulative incidence of skin cancers at 28 years was 5.3%. Over the 10-year period from January 2009 to December 2018, the standardized incidence ratio for premalignant in situ skin lesions increased, whereas the standardized incidence ratio for skin cancers decreased. Age at transplantation and treatment with more than two immunosuppressive agents were risk factors for the development of new skin cancers in organ transplant recipients. Over the most recent 10-year period, post-transplant skin cancers have been found earlier and diversified compared with in the previous period.

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“…It is presumed that long‐term immunosuppression increases the risk of recurrence of pretransplant malignancies and the risk of de novo malignancies . For example in this study, the risk of post‐transplant recurrence in patients with incidental colorectal cancers was 0% in stage 0 or I tumor, 33.3% in IIA tumor, and 100% in IIIA tumor, and 50% in stage IIIB tumor.…”

Section: Discussionmentioning

confidence: 57%

Treatment and outcomes of extrahepatic malignancy incidentally diagnosed during pretransplant evaluation for living donor liver transplantation

Park

Hwang

Song

et al. 2020

J Hepato Biliary Pancreat

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Background: This study analyzed treatment and outcomes in patients with primary extrahepatic malignancy (EHM) incidentally diagnosed during pretransplant evaluation for living donor liver transplantation (LDLT). Methods: Of 4621 adult patients undergoing LDLT over 19 years, 41 were diagnosed with EHM shortly before LDLT (incidental malignancy group), and 92 had been treated for EHM more than 6 months before LDLT (treated malignancy group). Results: Most common EHMs were colorectal, thyroid, and stomach cancers in the incidental malignancy group; and stomach, breast, thyroid, colorectal, and renal cell cancers and lymphoma in the treated malignancy group. Mean interval between EHM diagnosis and LDLT in the incidental malignancy group was 1.5 ± 1.6 months. Of the 41 patients in this group, 15 (35.6%), seven (17.1%), and 16 (39.0%) underwent EHM treatment before, during, and after LDLT, respectively, whereas three (7.3%) underwent observation alone.During a mean follow-up of 70.1 ± 50.8 months, six (14.6%) patients showed tumor recurrence, and three (7.3%) died of tumor progression. All recurrences developed in patients with tumor stages higher than the earliest stage. The mean interval between EHM diagnosis and LDLT in treated malignancy group was 79.8 ± 79.6 months. During a mean follow-up of 63.2 ± 54.1 months, three (3.3%) patients showed tumor recurrence and one (1.1%) died of tumor progression. The incidence of EHM recurrence was significantly higher (P = .025), and the overall post-transplant patient survival rate was significantly lower (P = .046), in the incidental malignancy than in the treated malignancy group. Conclusions: Only patients with earliest-stage EHM detected shortly before LDLT are indicated for upfront LDLT combined with peritransplant EHM treatment. K E Y W O R D Shepatocellular carcinoma, living donor liver transplantation, malignancy, recurrence, surveillance

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De novo malignancies after liver transplantation: The effect of immunosuppressionn-personal data and review of literature

Cited by 56 publications

References 156 publications

Current Trends and Characteristics of Hepatocellular Carcinoma in Patients with Autoimmune Liver Diseases

Current Trends and Characteristics of Hepatocellular Carcinoma in Patients with Autoimmune Liver Diseases

Twenty‐eight‐year incidence and characteristics of post‐transplant skin cancers: Comparative analysis of past and recent 10‐year experience

Treatment and outcomes of extrahepatic malignancy incidentally diagnosed during pretransplant evaluation for living donor liver transplantation

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