Risk of cancer in liver transplant recipients: A look into the mirror

Buell, Joseph F.; Brock, Guy

doi:10.1002/lt.21634

Cited by 8 publications

(7 citation statements)

References 29 publications

(67 reference statements)

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“…Studies reported in the literature are quite heterogeneous as, there was neither standardization among the series of patients who presented with DNT nor between the analytical methods. Other differences include the number of patients, ranging from 325 to 6846 [2], [19], [10], [11], [12], [13] and duration of observation time – from 5 to 27 years - in different periods ranging form 80s to 2006 [2], [10], [11], [14], [3], [15], that could affect the results.…”

Section: Discussionmentioning

confidence: 99%

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Early and Late De Novo Tumors after Liver Transplantation in Adults: The Late Onset of Bladder Tumors in Men

et al. 2013

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BackgroundDe novo tumors (DNT) after liver transplantation (LT) represent a growing concern.Patients and MethodsWe analyzed the incidence of DNT, type, time of onset, risk factors and mortality (as of 2010) in 494 adult patients transplanted in the last 26 years (1983–2009).ResultsDNT occurred in 41 (8.3%) of the patients. The Standardized Incidence Ratio (SIR) compared with the Italian population was 1.8. There was a higher incidence in males (SIR 2.0), an expected extremely high rate of Kaposi’s sarcoma (SIR 127.95) and unexpected higher rates of tumors of the bladder in males (SIR 3.3). The incidence of DNT was higher within the first two years of LT (SIR 2.7) for Kaposi’s sarcoma (SIR 393.3) and after 10 years (SIR 1.7) for bladder tumors (SIR 10.6). Multivariate analysis identified alcoholic cirrhosis (HR = 3.0, 95% CI = 1.2–7.8) and sclerosing cholangitis (HR = 3.5, 95% CI = 1.1–11.3) in the recipient as main risk factors for the occurrence of DNT.ConclusionsSurveillance protocols for DNT must be specifically oriented to patients transplanted for alcoholic cirrhosis and sclerosing cholangitis. They should focus on early detection of Kaposi’s sarcomas, and more remarkably, on late development bladder tumors in men after LT.

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Section: Discussionmentioning

confidence: 99%

“…In the few studies that have calculated SIRs for DNT the reported figures ranges from 2.2 to 4.0 [2], [19], [11], [3], [15], [20].…”

Section: Discussionmentioning

confidence: 99%

Early and Late De Novo Tumors after Liver Transplantation in Adults: The Late Onset of Bladder Tumors in Men

et al. 2013

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“…There is a clear link between the dose and duration of immunosuppressive therapy and the development of cancers after transplantation. [53][54][55] Most posttransplant immunosuppressive therapy entails an adjunctive agent (azathioprine), a corticosteroid, and a calcineurin inhibitor (cyclosporine). These agents have increased survival and reduced acute rejection by 10% to 15%.…”

Section: Cervical Cancer Screening In Other Immunocompromised Women Omentioning

confidence: 99%

Cervical Cancer Screening in Immunocompromised Women

Nguyen

Flowers

2013

Obstetrics and Gynecology Clinics of North America

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“…The reported risk for de novo cancer in liver transplant recipients is up to 2.1‐4.3 times higher compared to the matched general population, with an incidence varying between 3% and 26% 3‐10. The higher cancer risk after organ transplantation has been reported to be directly related to the intensity as well as the cumulative dose of immunosuppression 11. A dose reduction of cyclosporine A (CsA) to maintain a trough blood level from 200 ng/mL to 100 ng/mL in kidney transplant recipients resulted in a significant reduction in the de novo cancer incidence 12.…”

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confidence: 99%

Increased incidence of early de novo cancer in liver graft recipients treated with cyclosporine: An association with C₂ monitoring and recipient age

et al. 2010

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The goal of this study was to determine the risk factors for de novo cancer after liver transplantation (LTx). Retrospective analyses were performed in 385 LTx patients who underwent transplantation between 1986 and 2007. In total, 50 (13.0%) recipients developed de novo malignancy. The cumulative incidence of de novo cancer at 1, 5, 10, and 15 years after LTx was 2.9% 6 0.9%, 10.5% 6 1.8%, 19.4% 6 3.0%, and 33.6% 6 6.8%, respectively. The standardized incidence ratio of malignancy in LTx patients compared to the general population was 2.2 (95% confidence interval: 1.6-2.8). After excluding posttransplant lymphoproliferative disorder and skin cancer, patients with de novo cancer had a significantly lower survival rate compared to recipients who remained cancer-free. The identified univariate risk factors for de novo cancer were cyclosporine A (CsA) treatment, time period of LTx, and recipient age. In multivariate analysis, only CsA treatment emerged as an independent risk factor for de novo cancer, which was attributed to more aggressive cancer types. A surprising finding was that CsA treatment specifically enhanced cancer risk in patients who underwent transplantation after 2004, when C 2 monitoring (blood concentration at 2 hours postdose) was introduced. In addition, these patients showed a significantly lower acute rejection rate, which might reflect a more robust immunosuppressive status caused by the CsA-C 2 regimen. When age was considered, only patients 50 years had a higher cancer rate when treated with CsA compared to treatment with tacrolimus. Our data suggest that, compared to tacrolimus treatment, CsA treatment with C 2 monitoring or in younger patients of 50 years is associated with a higher early de novo cancer risk after LTx. Liver Transpl 16:837-846, 2010.

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Risk of cancer in liver transplant recipients: A look into the mirror

Cited by 8 publications

References 29 publications

Early and Late De Novo Tumors after Liver Transplantation in Adults: The Late Onset of Bladder Tumors in Men

Early and Late De Novo Tumors after Liver Transplantation in Adults: The Late Onset of Bladder Tumors in Men

Cervical Cancer Screening in Immunocompromised Women

Increased incidence of early de novo cancer in liver graft recipients treated with cyclosporine: An association with C₂ monitoring and recipient age

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Risk of cancer in liver transplant recipients: A look into the mirror

Cited by 8 publications

References 29 publications

Early and Late De Novo Tumors after Liver Transplantation in Adults: The Late Onset of Bladder Tumors in Men

Early and Late De Novo Tumors after Liver Transplantation in Adults: The Late Onset of Bladder Tumors in Men

Cervical Cancer Screening in Immunocompromised Women

Increased incidence of early de novo cancer in liver graft recipients treated with cyclosporine: An association with C2 monitoring and recipient age

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Increased incidence of early de novo cancer in liver graft recipients treated with cyclosporine: An association with C₂ monitoring and recipient age