Epidemiology

One in ten patients develops de novo cancer after liver transplantation

Last Updated: 2010-01-13 19:42:59 -0400 (Reuters Health)

By Michelle Rizzo

NEW YORK (Reuters Health) - Roughly 1 in 10 liver transplant recipients will develop a de novo malignancy within 10 years after transplantation, with the highest risks in patients transplanted for alcoholic liver disease or primary sclerosing cholangitis (PSC), researchers report in the December issue of Gastroenterology.

De novo malignancy is one of the leading causes of late mortality in patients who undergo liver transplantation, the researchers note.

Using data from three transplant centers - the Mayo Clinic, the University of Nebraska, and the University of California at San Francisco - the investigators analyzed de novo cancer rates in 798 adults who received new livers between 1990 and 1994.

About half were male, 80% were Caucasian, and their average age at transplant was 49.4 years.

According to lead author Dr. Kymberly D. S. Watt, from the Mayo Clinic in Rochester, Minnesota, 171 patients developed 271 de novo malignancies over a median follow-up period of 10 years. Most malignancies (147) were skin-related; 29 were hematologic, and 95 were solid organ cancers.

Of the 103 patients with non-skin malignancies, 26% had PSC and 25% had alcoholic liver disease.

Patients with these two conditions had the highest probability of developing any non-skin malignancy at 10 years (21.9% and 18.1%, respectively). Liver transplant patients with any other diagnosis had a 10% probability of developing a non-skin malignancy over the course of the study.

The 10-year cumulative incidence of solid organ malignancy was 17.0% with PSC, 15.4% with alcohol-related liver disease, and 7.4% with any other indication for transplant.

"The most common malignancies seen in the transplant population are skin cancers, but the most common solid organ cancers are gastrointestinal tract cancers, lung cancers, genitourinary tract cancers, and oropharyngeal cancers," Dr. Watt told Reuters Health in an email.

"We expected primary sclerosing cholangitis patients to have increased risk of colon cancer, but they also had increased risk of posttransplant lymphoproliferative disorder and skin cancers compared to all other transplant patients," she said.

Most of the risk for mouth and throat cancer or lung cancer was in patients with alcoholic liver disease, she added.

On multivariate analysis, age by decade (p = 0.014), smoking history (p = 0.029), alcoholic liver disease (p = 0.007), and PSC (p = 0.001) were risk factors for de novo solid organ malignancies.

The researchers reported mortality rates, but not cancer-specific mortality. At 1 year and 5 years after diagnosis of a non-skin malignancy, the probability of death was 40% and 55%, respectively. The probability of death after a diagnosis of a solid organ malignancy was 38% and 53% at 1 and 5 years, respectively.

"Screening for common malignancies like skin cancer should be undertaken in all transplant patients," Dr. Watt said. "Patients with PSC and alcohol-related liver disease...seem to be at highest risk and may require more intensive cancer screening protocols, whereas the rest of the transplant population will be served best with diligent screening as recommended to the general age-specific population (with patient-specific exceptions)."

Gastroenterology 2009;137:2010-2017.