Usefulness of a program of neoplasia surveillance in liver transplantation. A preliminary report

Abstract

De novo malignancies are frequent complications after liver transplantation. Aim of the study is to evaluate whether a surveillance program for malignancy may improve patient survival. We have compared the survival after the diagnosis of malignancy (excluding cutaneous and hepatobiliary carcinomas and lymphoproliferative disease) of patients with symptomatic or incidental malignancies with patients with neoplasia diagnosed on screening. Two hundred and eighty patients with a follow-up greater than three months were followed for a median of 77.5 months (total follow-up: 1515 patient-yr). Thirty-three patients developed 41 malignancies. When compared with general population, the entire cohort of liver transplant recipients had a significantly higher risk of malignancy (relative risk: 2.34), gastrointestinal tract (relative risk: 2.52), urological tract (relative risk: 2.94) and head and neck cancer (relative risk: 4.14), and cancer-related death (relative risk: 2.35). All nine patients diagnosed with cancer with active screening are currently alive and free of malignancy after a median follow-up of 25 months. By contrast, 18/24 patients with diagnosis of cancer prompted by symptoms or incidentally diagnosed died as a consequence of the cancer (median survival: 13.5 months). The difference in survival between both groups was significant (p = 0.002). In conclusion, a close surveillance protocol for the diagnosis of malignancy could be life-saving in liver transplant recipients.

Risk of Colorectal Carcinoma in Post-Liver Transplant Patients: A Systematic Review and Meta-analysis

“…This higher age could be a possible explanation for a higher observed IR of CRC in this cohort. Another explanation for the high IR could be the use of surveillance colonoscopy in this study (37). Asymptomatic CRC will be missed when no colonoscopy is offered, leading to an underestimation for CRC in those studies.…”

“…When the exclusion criteria were applied, the final 29 studies were included for review ( Figure 1) (2,6,16,36,37,40) were of high, 15 of medium (3,35,(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)) and 8 of low quality according to the DQS (38,39,(54)(55)(56)(57)(58)(59). A pretransplantation screening protocol for LTx evaluation was mentioned in 2 studies (16,37 (3,6,37,40,45,52,53). Weighted age-matched control IR for the overall IR pooled analysis: In total, for 13 studies an age at the end of follow-up was extracted (2,6,16,35,37,40,(44)(45)(46)…”

“…After pooling the 10 studies (Figure 4) (2,6,16,37,40,45,49,52,53) (48,65,66 (6,37). One of these two studies reported a mean age of LTx of 56 years (37).…”

Long-Term Results of Liver Transplantation

“…EBV viral-load monitoring may aid in identification of patients at risk for PTLD. Recent data reveal that the introduction of intensified posttransplant surveillance (including annual CTs and urologic, gynecologic, and dermatologic screening) improved short-term survival (29,34), but the studies neglected to address the consequence of the amount of radiation exposure from such a strategy. In an immune suppressed state, the carcinogenicity of radiation might be augmented.…”

The AJT Report: News and issues that affect organ and tissue transplantation

“…A similar argument was made by Spanish researcher J. Ignacio Herrero, MD, a hepatologist who is on the Transplant Committee of the University of Navarra Hospital in Pamplona, Spain, and his team: They called for a close surveillance protocol for the diagnosis of malignancy. 5 When asked whether his studies have encouraged his European colleagues to increase cancer surveillance, he says "most European liver transplant programs do not have a program of neoplasia surveillance for their patients, but the increasing numbers of patients dying of neoplasia with a functioning graft is moving some of them to surveillance." Dr. Feng is impressed with the intensive screening program.…”