title: De novo malignancies after intestinal and multivisceral transplantation.
abstract: BACKGROUND
  Maintenance immunosuppression required after organ transplantation creates a permissive environment in which cancer cells can proliferate because of lack of natural immunologic surveillance. With more than a decade of clinical experience, this report is the first to address the risk of de novo cancer after intestinal transplantation.
  
  
  METHODS
  A total of 168 consecutive intestinal transplant recipients (86 children and 82 adults) were studied, of whom 52% were male and 91% were white. Surveillance, Epidemiology, and End Results data was used to count expected rates of de novo cancers in the general population matched for age, sex, and length of follow-up.
  
  
  RESULTS
  With a mean follow-up of 47+/-41 months, 7 (4.2%) patients developed nonlymphoid de novo cancer, with a cumulative risk of 3% at 5 years and 28% at 10 years. Of these malignancies, one was donor-driven adenocarcinoma. With 0.58 being the expected rate of malignancy for the general population, the risk among intestinal recipients was 8.7 times higher (P =0.01). Such morbidity was significantly higher (50 times) among younger patients (<25 years), with a slight male preponderance. Induction immunosuppression was associated with early onset of de novo cancer. Patient survival after diagnosis of de novo cancer was 72% at 1 year, 57% at 2 years, and 29% at 5 years.
  
  
  CONCLUSIONS
  With conventional immunosuppression, intestinal recipients are at a significantly higher risk of developing de novo cancer when compared with the general population. Thus, a novel tolerogenic immunosuppressive strategy has been recently implemented to reduce the lifelong need for immunosuppression.
authors.affiliation: Thomas E. Starzl Transplantation Institute, Pittsburgh, PA 15213, USA. abuelmagdkm@upmc.edu
authors.forename: Kareem M
authors.initials: KM
authors.lastname: Abu-Elmagd
authors.forename: Marsha
authors.initials: M
authors.lastname: Zak
authors.forename: June M
authors.initials: JM
authors.lastname: Stamos
authors.forename: Geoff J
authors.initials: GJ
authors.lastname: Bond
authors.forename: Ashok
authors.initials: A
authors.lastname: Jain
authors.forename: Ada O
authors.initials: AO
authors.lastname: Youk
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ezzelarab
authors.forename: Guilherme
authors.initials: G
authors.lastname: Costa
authors.forename: Tong
authors.initials: T
authors.lastname: Wu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Nalesnik
authors.forename: George V
authors.initials: GV
authors.lastname: Mazariegos
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Sindhi
authors.forename: Amadeo
authors.initials: A
authors.lastname: Marcos
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Demetris
authors.forename: John J
authors.initials: JJ
authors.lastname: Fung
authors.forename: Jorge D
authors.initials: JD
authors.lastname: Reyes
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000375:Aging; D002648:Child; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D015994:Incidence; D007223:Infant; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D016377:Organ Transplantation / Q000009:adverse effects; D011860:Radiography, Abdominal; D018570:Risk Assessment; D012727:Sex Characteristics; D016019:Survival Analysis; D014019:Tissue Donors; D014057:Tomography, X-Ray Computed; D014781:Viscera / Q000637:transplantation*