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

Abstract

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

Evaluation and Management of Liver Transplant Candidates With Prior Nonhepatic Cancer: Guidelines From the ILTS/SETH Consensus Conference

“…Four clinical practice guidelines focused on the management of LT patients, and several consensus documents have been proposed; however, none of these refer specifically to the surveillance of cancer recurrence after LT. 9,15,33,56-58 In selected PTM patients, however, the risk of posttransplant tumor recurrence has been shown to be comparable with that of patients with posttransplant de novo malignancy. 59-63…”

“…Four clinical practice guidelines focused on the management of LT patients, and several consensus documents have been proposed; however, none of these refer specifically to the surveillance of cancer recurrence after LT. 9,15,33,[56][57][58] In selected PTM patients, however, the risk of posttransplant tumor recurrence has been shown to be comparable with that of patients with posttransplant de novo malignancy. [59][60][61][62][63] Virus-associated tumors or preneoplastic lesions diagnosed before LT, such as those related to human papillomavirus, should also be considered in follow-up after LT 64,65 because conditions that suppress cell-mediated immunity are associated with these virus-induced cancers. Human papillomavirus is one of the most common sexually transmitted infections and is associated with cancers of the anogenital region.…”