Recurrent non-hepatic and de novo malignancies after liver transplantation

This chapter consists of two parts: first, recurrence of non-hepatic malignancy which liver transplant (LTx) recipients had prior to or at the time of transplant, and second, de novo malignancy which recipients did not have prior to transplant. The recurrence rate of malignancy post-LTx is low. In four studies consisting of 3718 LTx recipients, 108 had malignancies prior to LTx; seven of them recurred post-LTx. 17 LTx patients had myeloproliferative disorders at the time of transplant; one had a recurrence. Post-LTx recurrence for neuroendocrine tumor is high; however, transplant is only performed in highly selected cases. For epidermal, skin cancer, recurrence is frequent. De novo malignancy is the commonest cause of death for adults post-LTx in long term. Since 1998, studies are reported with standard incidence ratio (SIR), where patients' age, gender, and length of follow-up (total person-years calculated by adding survival of each patient) are compared with epidemiological data for each cancer type. This method provides the precise incidence of cancer post-LTx compared to general population. Rates of malignancy increase in proportion to age at transplant and length of follow-up. Skin cancer is the commonest malignancy post-LTx. Certain risk factors for post-transplant de novo cancers are identified: ethanol-induced cirrhosis, smoking (oropharyngeal, lung, esophageal), Barrett’s esophagus (esophageal), and primary sclerosing cholangitis with inflammatory bowel disease (colorectal). The rates of gynecological and breast cancers post-LTx are lower than general population in most studies. There are geographical differences; gastrointestinal cancers in Korea and renal cell carcinomas in Netherlands and Taiwan have higher rates.