De novo malignancies after intestinal and multivisceral transplantation.
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.
Abu-Elmagd
Kareem M
KM
Thomas E. Starzl Transplantation Institute, Pittsburgh, PA 15213, USA. abuelmagdkm@upmc.edu
Zak
Marsha
M
Stamos
June M
JM
Bond
Geoff J
GJ
Jain
Ashok
A
Youk
Ada O
AO
Ezzelarab
Mohamed
M
Costa
Guilherme
G
Wu
Tong
T
Nalesnik
Michael A
MA
Mazariegos
George V
GV
Sindhi
Rakesh K
RK
Marcos
Amadeo
A
Demetris
Anthony J
AJ
Fung
John J
JJ
Reyes
Jorge D
JD
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*