Incidence and outcomes of de novo malignancies after living donor liver transplantation in comparison with the Japanese general population
演題番号 : P76-7
Background: De novo malignancies after adult living donor liver transplantation (LT) in comparison with the general population have rarely been described.
Methods: A single-center, retrospective cohort analysis was conducted for 136 adult patients who underwent LDLT between 1995 and 2014.
Results: A total of 12 recipients developed 13 (10%) de novo malignancies.
For solid tumors (n=9), the median duration from transplant to diagnosis was 6.3 years. Five patients have been followed >1 year after cancer treatment: One male presented with back pain caused by sacral metastasis from thyroid carcinoma and died of disease progression 1.1 year after cancer diagnosis. Four remaining patients (thyroid, 1; colorectal, 2; laryngeal/lung, 1) are disease free. Three patients (lung, 1; gastric, 1; prostate, 1) underwent curative resection within 1 year and are doing well. Our annual surveillance program detected only 3 patients with cancer (lung, 2; colorectal, 1).
For posttransplant lymphoproliferative disorders (PTLD, n=4), the median interval from LT was 9.8 years. All patients were EBV-PCR negative. Pathological diagnosis was diffuse large B-cell lymphoma in 3 and Hodgkin lymphoma in 1. Complete response was achieved in 2 patients after R-CHOP and both are alive >3 years. PTLD relapsed in 1 female who received rituximab alone and she died 4 months thereafter. Calcineurin inhibitor was reduced in 1 remaining patient and she is now under strict follow-up.
Overall, the incidence of all cancers was significantly elevated in LT recipients compared with the Japanese population (standardized incidence ratio, 2.9; 95% confidence interval, 1.6-4.8); however, cancer mortality rate was comparable (standardized incidence ratio, 1.6; 95% confidence interval, 0.2-5.8)
Conclusions: Cancer deaths after adult LDLT are equivalent to those of the Japanese general population. An effective surveillance program is strongly needed. Risk factors and prognostic indicators of PTLD remain to be elucidated.