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. 2017 Aug;101(8):1859-1866.
doi: 10.1097/TP.0000000000001725.

Risk Factors and Outcomes of De Novo Cancers (Excluding Nonmelanoma Skin Cancer) After Liver Transplantation for Primary Sclerosing Cholangitis

Mohamad A Mouchli  1 , Siddharth Singh, Edward V Loftus Jr, Lisa Boardman, Jayant Talwalkar, Charles B Rosen, Julie K Heimbach, Russell H Wiesner, Bashar Hasan, John J Poterucha, Watt D Kymberly
Affiliations

Risk Factors and Outcomes of De Novo Cancers (Excluding Nonmelanoma Skin Cancer) After Liver Transplantation for Primary Sclerosing Cholangitis

Mohamad A Mouchli et al. Transplantation. 2017 Aug.

Abstract

Background: Patients with primary sclerosing cholangitis (PSC) may be at higher risk of malignancy after liver transplantation (LT) compared to other LT recipients. We aimed to determine the cumulative incidence of/risk factors for long-term cancer-related mortality in patients with PSC after LT.

Methods: All adult patients underwent LT for PSC without cholangiocarcinoma from 1984 to 2012, with follow-up through June 2015. We estimated cumulative incidence, risk factors, and mortality from de novo malignancies after LT.

Results: Two hundred ninety-three patients were identified (mean [SD] age, 47 [12] years; 63.3% males; 2.4% smoking at LT). Over a median of 11.5 years (range, 6.4-18.6 years), 64 patients (21.8%) developed 73 nonskin cancers, including 46 solid-organ cancers (renal, 11; colorectal, 11; prostate, 7; breast, 5; pancreas, 5; ovarian/endometrial/vulvar cancers, 3; and de novo cholangiocarcinoma, 4). Twenty-two patients developed hematologic malignancies (posttransplant lymphoproliferative diseases, 18; Hodgkin disease, 2; and myelodysplastic syndrome, 2). Five patients developed melanoma. The 1-, 5-, 10-, and 20-year cumulative incidences of cancer were 2.1%, 8.6%, 18.7%, and 27%, respectively. Mortality of patients with PSC who developed cancer was higher than that of patients with PSC without cancer (hazard ratio, 2.2; P < 0.01). On multivariate analysis, recipient's age and elevated pre-LT international normalized ratio were associated with increased risk of de novo (nonskin) malignancy.

Conclusion: The 10-year cumulative risk of cancer after LT for advanced-stage PSC was 18.7%, with posttransplant lymphoproliferative diseases, colorectal cancer, and renal cell cancer being the most common. Post-LT de novo nonskin cancer decreased overall posttransplant survival. Only recipient's age and elevated international normalized ratio at LT were associated with increased nonskin cancer risk.

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Conflict of interest statement

Disclosures: The authors have no financial or personal relationships that could present a potential conflict of interest.

Figures

Figure 1
Figure 1
Selection of patients included in the determination of de novo malignancies after LT for PSC
Figure 2
Figure 2
Cumulative incidence of cancer after liver transplantation for PSC (competing risk analysis)
Figure 3
Figure 3
Cumulative incidence of death after liver transplantation for PSC
See this image and copyright information in PMC

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