Long Term Follow-Up of Patients with De Novo Tumors after 1300 Liver Transplantations: A Case-Control Study

Long-term survival data on de novo malignancy are limited following orthotopic liver transplantation (OLT) when compared with controls without malignancies. Methods: Over a 23 yr period at our institution, 86 of 1300 patients (6.6%) who underwent OLT were identifi ed to have 86 de novo malignancies. The clinical characteristics and survival of these patients were retrospectively reviewed and compared with a control cohort of 86 OLT recipients without malignancy matched with the incidence cases by age, year of OLT, sex, and type of liver disease. Results: Chronic hepatitis C (49%) and B virus (20%), alcohol (18.4%) were the three leading causes of liver disease. Skin cancer was the most common malignancy (26%) including 5 cases of Kaposi disease, followed by gastrointestinal (24.6%) and hematological malignancies (PTLD) (17%), eye and rhynopharinx cancers (12.3%), lung cancers (7.6%), breast cancer (6.1%) and urinary cancers (4.6%). The cases and controls were not signifi cantly different in the immunosuppressive regimen (66% vs 74% Neoral and 34% vs 26% Prograf, p=0.42), the number of rejection episodes (15 vs 16,p=0.92), the gender (71% vs 69% male and 29% vs 31% female, p=0.67) the median recipient age (53 vs 51, p=0.63) and donor age (48.89 ± 20.3 vs 44.27 ± 17.3, p=0.52). The median time of the diagnosis of de novo tumor after OLT was 4.17 ± 3.77 years (0.4-16.2). The 5- and 10-year Kaplan–Meier survival rates for the cases were 84% and 62%, respectively, vs. 79% and 72%, respectively, for the controls (p=NS by log-rank test). Patients with skin cancers had 10- year survival similar to the controls (88% vs 72%,p=NS), but signifi cantly better than non-skin cancers (88% vs 56%, p=0.0001). The prognosis for patients with gastrointestinal tumors was poor, with a median survival of 8.6 months after the diagnosis. Conclusion: In this single institutional study, de novo malignancies after OLT were uncommon. Patients with non-skin cancer after OLT had diminished long-term survival compared with the controls. Following the poor prognosis of gastrointestinal cancers, it is mandatory an yearly surveillance after OLT to treat eventually this kind of tumors at an early stage.