These two authors contributed equally to this study.
Impact of cyclosporine versus tacrolimus on the incidence of de novo malignancy following liver transplantation: a single center experience with 609 patients
Article first published online: 16 AUG 2013
© 2013 Steunstichting ESOT. Published by John Wiley & Sons Ltd
Volume 26, Issue 10, pages 999–1006, October 2013
How to Cite
Wimmer, C. D., Angele, M. K., Schwarz, B., Pratschke, S., Rentsch, M., Khandoga, A., Guba, M., Jauch, K.-W., Bruns, C. and Graeb, C. (2013), Impact of cyclosporine versus tacrolimus on the incidence of de novo malignancy following liver transplantation: a single center experience with 609 patients. Transplant International, 26: 999–1006. doi: 10.1111/tri.12165
Conflicts of interest
No conflicts of interest.
- Issue published online: 16 SEP 2013
- Article first published online: 16 AUG 2013
- Accepted manuscript online: 26 JUL 2013 08:56AM EST
- Manuscript Accepted: 21 JUL 2013
- Manuscript Revised: 5 MAY 2013
- Manuscript Received: 10 APR 2013
- calcineurin inhibitor;
- cancer development;
- liver transplantation;
- long-term survival;
- multivariate analysis;
- risk factors
De novo malignancies are a major cause of late death after liver transplantation. Aim of the present study was to determine whether use of cyclosporine versus tacrolimus affects long-term tumor incidence considering potential confounders. De novo malignancies in 609 liver transplant recipients at Munich Transplant Centre between 1985 and 2007 were registered. In 1996, the standard immunosuppressive regimen was changed from cyclosporine to tacrolimus. Different effects of those drugs on long-term tumor incidence were analyzed in multivariate analysis. During 3765 patient years of follow-up (median 4.78 years), 87 de novo malignancies occurred in 71 patients (mean age 47.5 ± 13.3 years, mean time after liver transplantation 5.7 ± 3.7 years). The cumulative incidence of de novo malignancies was 34.7% for all tumor entities after 15 years as compared to 8.9% for a nontransplanted population. The most frequent tumors observed were nonmelanoma skin cancers (44.83%). Moreover, post-transplant lymphoid disease, oropharyngeal cancer (n = 6, 6.9%), upper gastrointestinal tract cancer (n = 4, 4.6%), lung cancer (n = 4, 4.6%), gynecological malignancies (n = 4, 4.6%), and kidney cancer (n = 3, 3.45%) were detected. Multivariate analysis revealed recipient age [hazards ratio (HR) 1.06], male gender (HR 1.73), and tacrolimus-based immunosuppression (HR 2.06) as significant risk factors. Based on those results, a tacrolimus-based immunosuppression should be discussed especially in older male patients. Whether reducing tacrolimus target levels may reduce the risk for de novo malignancies has yet to be determined in prospective trials.