title: Addition of MMF to dual immunosuppression does not increase the risk of malignant short-term death after liver transplantation.
abstract: Immunosuppression is often incriminated for the increased risk of post-transplant malignancies. To examine whether triple- (MMF+Tacro+CS) versus dual-drug therapy (Tacro+CS) is associated with an increased incidence of malignancy, or death due to malignancy, data from a large registry of liver transplant recipients were analyzed. Data from adult primary liver recipients reported to the Scientific Registry of Transplant Recipients between June 1, 1995, and April 30, 2004, and recorded at transplant on triple-drug (n = 9180) or dual-drug (n = 10 099) therapy were included. Kaplan-Meier survival analysis showed no significant differences in death due to malignancy 4 years post-transplantation between the treatment groups. Multivariable analysis using Cox proportional hazard models confirmed no differences in risk of death due to malignancy between the groups (HR: 0.83, p = 0.107). Incidence of any post-transplant malignancy was also not significantly different. Older recipient age and cause of liver disease were significantly associated with an increased risk of malignancy-related death. These data utilizing relatively short follow-up suggest the addition of MMF to Tacro+CS at transplant is not associated with death due to malignancy, at least in the short term. Individual recipient factors appear to be important risk factors for malignancy-related death; elucidating these risk factors can assist in identifying who should be monitored most aggressively for post-transplant malignancies.
authors.affiliation: Department of Medicine, University of Minnesota, Liver Transplantation Program, Fairview University Medical Center, Minneapolis, Minnesota, USA. lakex009@umn.edu
authors.forename: J R
authors.initials: JR
authors.lastname: Lake
authors.forename: K M
authors.initials: KM
authors.lastname: David
authors.forename: B J
authors.initials: BJ
authors.lastname: Steffen
authors.forename: A H
authors.initials: AH
authors.lastname: Chu
authors.forename: R D
authors.initials: RD
authors.lastname: Gordon
authors.forename: R H
authors.initials: RH
authors.lastname: Wiesner
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D015994:Incidence; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D009369:Neoplasms / Q000401:mortality; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D016019:Survival Analysis; D016559:Tacrolimus / Q000008:administration & dosage*
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus