De novo malignancies and liver transplantation

• Published in: Transplantation proceedings Vol. 35; no. 5; pp. 1896 - 1897
• Main Authors: Rubio, E, Moreno, J.M, Turrión, V.S, Jimenez, M, Lucena, J.L, Cuervas-Mons, V
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-08-2003; Elsevier Science
• Subjects: Adult; Aged; Biological and medical sciences; Case-Control Studies; Cause of Death; Follow-Up Studies; Humans; Liver Neoplasms - mortality; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Middle Aged; Neoplasms - epidemiology; Neoplasms - mortality; Postoperative Complications - mortality; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surgery of the urinary system; Survival Analysis; Time Factors; Transplantation, Homologous; Human; Immunosuppression; Treatment; Digestive system; Surgery; Liver; Graft; Complication; Transplantation; Malignant tumor; Homotransplantation; De novo
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/S0041-1345(03)00645-6

De novo tumors (DNTs) are the leading cause of late death among liver transplant recipients with an incidence of 5% to 15%, which is significantly greater than the general population. In this retrospective study, we compared this complication in liver transplant recipients to sex- and age-matched controls.
Among 410 patients who received liver allografts between March 1986 and December 2000, 32 (7.8%) developed a DNT. Epidermoid tumors were the most frequent histologic lineage. A complete response was observed in 19 patients (59.4%), a partial response in eight (25%), and no response in five (15%). Survival was lower among liver transplant recipients than controls, a difference that was statistically significant. Treatment consisted of surgery in 76.7%, radiotherapy in 16.7%, chemotherapy in 13.3%, and reduction of immunosuppression in 10%.
The mean survival time in transplant patients of 122.97 months (95% CI; range 98–147 months) was significantly shorter than controls, 156.5 months (95% CI; range 141–171 months). About 50% of patients were smokers (active or ex-smokers), compared to 20.7% of controls (
P = .049). Significant differences were also found when the three subgroups (smokers, previous smokers, and nonsmokers) were analyzed separately (
P = .013). Patients were smokers (active or nonactive) among 45% of cases of skin tumors; 60% of hematological tumors; 71.4% of epidermoids; and 33% of sarcomas.
DNTs, a complication of long-term immunosuppression in patients after liver transplantation, most frequently presented as skin tumors and PTLD. Occurrence of a DNT was an adverse prognostic factor for survival. Smoking represents an independent risk factor for these tumors.