Malignancy After Liver Transplantation: Cumulative Risk For Development

Background. Solid organ recipients are at high risk to develop malignancies due to the complex interactions of several factors, constituting a major cause of late death after transplantation.Patients and Methods. We retrospectively reviewed an historic cohort of adult liver recipients from cadaveric donors (multiorgan recipients excluded) performed from 1986-2002 with a minimum follow-up of 36 months. The Kaplan-Meier method was used to assess cumulative risk to develop malignancy and survival analyses.Results. Among the 528 patients undergoing orthotopic liver transplantation (OLT) with a mean follow-up of 2400 days, 98 developed cancer among which 25% were skin malignancies. Sixty-seven patients developed at least I noncutaneous malignancy, an overall incidence of 12.7%. Eighteen percent suffered from posttransplant lymphoproliferative disease; 14%, lung cancer; 4%, Kaposi's sarcoma; 7%, genitourinary malignancies; and 1.7%, oropharyngeal or laryngeal cancer. The cumulative patient risks to develop noncutaneous malignancies at 5, 10, and 15 years posttransplantation were 9% (confidence interval [Cl]: 0.06-0.11), 18% (Cl: 0.14-0.23), and 25% (Cl: 0.18-0.31.), respectively.Conclusions. OLT recipients are at higher risk to develop malignancies after transplantation, reaching a cumulative risk of 25% at 1.5 years. Long-term surveillance measures and screening programs must be seriously conducted for selected groups.