[Characterization of de novo malignancies in liver transplantation].
BACKGROUND
The incidence of de novo malignancies after liver transplantation varies from 3-15%, and is greater than that in the general population. Immunosuppression may play a significant role in the development of most of these tumors.


OBJECTIVE
To evaluate the incidence and clinical features of de novo tumors in liver transplant recipients in our center as well as to assess survival.


METHODS
We retrospectively analyzed 437 liver transplantations (380 patients) performed from April 1990 to July 2001. The incidence of de novo malignancies was 7.4% (n = 28). Four patients presented two different tumors during their lifetime. The etiology of the underlying disease was alcoholic cirrhosis (45.8%), hepatitis C virus cirrhosis (20.8%), hepatitis B virus cirrhosis (12.5%), autoimmune disease (8.4%) and other causes (12.5%). The most frequent neoplasms were cutaneous and epidermoid tumors (21.4% of the malignancies both groups). All the patients with epidermoid tumors and adenocarcinomas were active smokers. The mean age at diagnosis was 58 9 years and this was a factor that influenced tumoral type (adenocarcinomas in older patients and epidermoid tumors in younger patients; p = 0.04).


RESULTS
Sarcomas and adenocarcinomas appeared sooner after transplantation than epidermoid and cutaneous tumors (p = 0.04). Fifty percent of the malignancies developed in the second and third year after transplantation. The type of immunosuppression did not influence tumoral type, although most patients received cyclosporin A in combination with azathioprine and/or corticoids. The mean duration of follow-up after diagnosis of the tumor was 23.1 28 months (range, 1-81). Mortality was 58.4% with a median survival of 9 16 months. The actuarial probability of survival at 1, 3 and 5 years was 46.1, 27.7 and 27.7%, respectively.


CONCLUSIONS
De novo malignancies are frequent after liver transplantation and their clinical course differs from that in the general population. Because their clinical course is more aggressive, regular follow-up of these patients is essential for early diagnosis.
Catalina
M V
MV
Servicio de Aparato Digestivo. Unidad de Trasplante Hepático. Hospital General Universitario Gregorio Marañón. Madrid. España.
de Diego
A
A
García-Sánchez
A
A
Escudero
M
M
Salcedo
M
M
Bañares
R
R
Clemente
G
G
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate