Risk of virus and non‐virus related malignancies following immunosuppression in a cohort of liver transplant recipients. Italy, 1985–2014

Abstract

This cohort study assessed, in Italy, the overall pattern of risk of de novo malignancies following liver transplantation (LT). The study group included 2,832 individuals who underwent LT between 1985 and 2014 in nine centers all over Italy. Person-years (PYs) at cancer risk were computed from 30 days after LT to the date of cancer diagnosis, to the date of death or to the end of follow-up. Excess cancer risk, as compared to the general population, was estimated using standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). During 18,642 PYs, 246 LT recipients developed 266 de novo malignancies, corresponding to a 1.8-fold higher cancer risk (95% CI: 1.6-2.0). SIRs were particularly elevated for virus-related malignancies, including Kaposi's sarcoma (SIR = 53.6, 95% CI: 30.0-88.5), non-Hodgkin lymphomas (SIR = 7.1, 95% CI: 4.8-10.1) and cervix uteri (SIR = 5.4, 95% CI: 1.1-15.8). Among virus-unrelated malignancies, elevated risks emerged for head and neck (SIR = 4.4, 95% CI: 3.1-6.2), esophagus (SIR = 6.7, 95% CI: 2.9-13.3) and adrenal gland (SIR = 22.9, 95% CI: 2.8-82.7). Borderline statistically significant elevated risks were found for lung cancer (SIR = 1.4, 95% CI: 1.0-2.1) and skin melanoma (SIR = 2.6, 95% CI: 1.0-5.3). A reduced risk emerged for prostate cancer (SIR = 0.1, 95% CI: 0.0-0.5). These findings underline the need of preventive interventions and early detection of malignancies, specifically tailored to LT recipients.

Hepatocellular carcinoma and the risk of de novo malignancies after liver transplantation – a multicenter cohort study

“…De novo malignancies (DNMs) are a leading cause of death in liver transplant (LT) recipients [1][2][3][4][5][6][7][8], and survival probability of LT recipients, who develop a DNM, is generally lower than that of nontransplanted patients with the same tumor [9,10].…”

Survival after the diagnosis of de novo malignancy in liver transplant recipients

“…Solid‐organ transplant recipients are known to be at higher risk of developing several cancer types, mainly virus‐related malignancies, compared with the general population . The large number of investigations that have explored cancer incidence in transplant recipients has not been paralleled by investigations focused on the prognostic impact of de novo malignancies (DNMs) .…”

“…Solid-organ transplant recipients are known to be at higher risk of developing several cancer types, mainly virus-related malignancies, compared with the general population. [1][2][3][4] The large number of investigations that have explored cancer incidence in transplant recipients has not been paralleled by investigations focused on the prognostic impact of de novo malignancies (DNMs). 5,6 The few studies conducted in the setting of liver transplant (LT) have suggested that the increased tumor burden among LT recipients may substantially impair their overall survival.…”

“…Adjusted for gender, age at transplant, and year at transplant 2. Reference category 3. The sum does not add up to the total because of missing values.…”

Decreased incidence of Kaposi sarcoma after kidney transplant in Italy and role of mTOR‐inhibitors: 1997–2016

“…3 We have already published research findings showing the high risk of KS in Italian kidney and liver transplant recipients, with crude incidence rates 16-times or 6.3-times higher, respectively, than those reported by Cahoon and colleagues. 4,5 In our study, we compare time trends of KS in Italian transplant recipients with the temporal pattern described in the US by Cahoon and colleagues. To this end, using data on 11,624 recipients of kidney transplants (KTX) performed between 1997 and 2013 in 17 centers followed-up up to December 2016, we investigated trends of KS incidence highlighting the role of mTOR-inhibitors (mTORi).In a total of 85,705 person-years (PYs) of observation (median length of follow-up 7.3 years), 106 cases of KS were diagnosed, with a crude incidence rate of 123.7 KS cases/10 5 PYs, 10-times higher than the crude incidence reported in the US study conducted by Cahoon and colleagues.…”