The Impact of De novo Tumors after Liver Transplantation on Long Term Survival

Background and aims: the purpose of this study is to describe de novo post-liver transplant (LT) malignancies and compare their frequency with incidence rates from Italian cancer registries. Methods: three hundred and thirteen patients subjected to LT, from 1991 to 2006, surviving 12 months and without diagnosis of previous cancer (including hepatocellular carcinoma), were evaluated for development of de novo malignancies excluding non-melanoma skin cancers. Results: during a total follow-up time of 1,753 person years (PYs), 40 (12.8%) de novo malignancies were diagnosed in 40 recipients. The most common cancers were non-Hodgkin lymphoma (NHL) (20%), cancer of the head and neck (17%), Kaposi sarcoma (KS) (17%) and esophageal tumors (12%). The 1, 3, 5 and 10 years estimated survival were 70%, 56%, 48% and 39%. Patients with de novo cancers had a lower 10 years survival (p=0.0047) than patients without (39% vs 75%). The risk of cancer after LT was 3-fold higher than that of the general population of the same age and sex (95% CI:2.0-4.3). De novo tumor sites or types with significantly elevated standardized incidence ratio (SIR) included KS (SIR=212), NHL (SIR=13.7), oesophagus (SIR=18.7), melanoma (SIR=10.1) and head and neck cancers (SIR=4.6). Conclusion: tumors after LT are associated with lower long-term survival, confirming that cancer is a major cause of late mortality.