De novo malignancies after liver transplantation: A major cause of late death

Authors

  • John J. Fung MD, PhD,

    Corresponding author
    1. Division of Transplantation Surgery, The Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
    • Thomas E. Starzl Transplantation Institute, University of Pittsburgh, 3601 Fifth Ave, Pittsburgh, PA 15213. Telephone: 412-647-9577; FAX: 412-647-5480
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  • Ashok Jain,

    1. Division of Transplantation Surgery, The Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
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  • E. J. Kwak,

    1. Division of Transplantation Infectious Diseases, The Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
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  • Shimon Kusne,

    1. Division of Transplantation Infectious Diseases, The Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
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  • Igor Dvorchik,

    1. Division of Transplantation Surgery, The Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
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  • Bijan Eghtesad

    1. Division of Transplantation Surgery, The Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Abstract

Key Points

  • 1Recurrent and de novo malignancies are the second leading causes of late death in liver transplant recipients, following age-related cardiovascular complications.
  • 2The increased incidence of de novo malignancies in liver transplant recipients compared with the general population reflects their demographic makeup, known preexistent risk factors for cancer, greater rate of chronic viral infection, and actions of exogenous immunosuppression.
  • 3The greatest incidence of de novo malignancies is seen in cancers associated with chronic viral infections, such as Epstein-Barr virus–associated posttransplant lymphoproliferative disease, and skin cancers, including squamous cell carcinoma and Kaposi's sarcoma.
  • 4Although a greater incidence of such malignancies as oropharyngeal malignancy and colorectal cancer was noted, there did not appear to be an increased risk for liver transplant recipients matched for age, sex, and length of follow-up using modified life-table technique and Surveillance Epidemiology End Result data with a similar at-risk group. However, they may present with more advanced stages of disease.
  • 5An increased incidence of de novo cancers in chronically immunocompromised liver transplant recipients demands careful long-term screening protocols to help facilitate diagnosis at an earlier stage of disease.

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