Epidemiology

Cancer incidence increased after liver transplantation

Last Updated: 2008-10-10 17:09:59 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The risk of de novo cancer is higher in liver transplant recipients than in the general population, according to a study in Finland. The increased incidence is particularly pronounced among children, the researchers report in the October issue of the journal Liver Transplantation.

"On the basis of our data," Dr. Fredrik Aberg and co-authors note, "1 of 6 liver transplant patients is estimated to develop some form of cancer by 20 years after transplantation."

Although posttransplant malignancies are a recognized problem, "more studies are needed to obtain reliable data on cancer risk patterns in an attempt to reach consensus on optimal monitoring of immunosuppression, cancer surveillance programs, and strategies to minimize cancer risk," the authors maintain.

Their study included all Finnish patients who received liver transplants at the Helsinki University Central Hospital between 1982 and 2005 (n = 540), linked with the nationwide Finnish Cancer Registry. During 3222 person-years of follow-up, there were 39 de novo cancers in 36 patients (standardized incidence ratio = 2.59) plus 11 basal cell carcinomas of the skin (SIR 3.70).

Rates were higher among children < 17 years old (SIR 18.1) than among patients ages 17-39 (SIR 5.77) and patients age 40 and older (SIR 2.27). Time from transplantation to detection of cancer ranged from 4 to 172 months (mean, 61 months).

Non-Hodgkin lymphoma, non-melanoma skin cancer, and basal cell carcinoma were the only types to show significantly elevated SIRs (13.9, 38.5, and 3.70, respectively). Of the 8 patients with non-Hodgkin's lymphoma, 4 had cases of post-transplant lymphoproliferative disorder.

Risk factors for skin cancer were older age and antibody induction therapy, while those for non-Hodgkin lymphoma were male gender, young age, and the immediate posttransplant period.

According to Dr. Aberg's team, "This study points out the importance of cancer surveillance after liver transplantation as well as the need for innovative immunosuppression strategies associated with less cancer risk."

In a related editorial, Dr. Ashokkumar Jain at the University of Rochester in New York, and colleagues review other reports of post-liver transplantation de novo cancers. They point out that such reports are difficult to compare, based on authors' inclusion or exclusion of lymphoid malignancies and a wide variation in reported cancer types by region.

In general, they note, "The overall rate of de novo solid tumors increases with age at the time of transplant and the length of follow-up, whereas the rate of post-transplant lymphoproliferative disease decreases with age at liver transplantation, with a higher incidence in the first few years post-transplant."

Liver Transpl 2008;14:1406-1411,1428-1436.