title: De novo malignancies following liver transplantation: a case-control study with long-term follow-up.
abstract: BACKGROUND
  Long-term survival data on de novo malignancy are limited following orthotopic liver transplantation (OLT) when compared with controls without malignancies.
  
  
  METHODS
  Over a 12 yr period at our institution, 50 of 1043 patients (4.8%) who underwent OLT were identified to have 53 de novo malignancies. The clinical characteristics and survival of these patients were retrospectively reviewed and compared with a control cohort of 50 OLT recipients without malignancy matched with the incidence cases by age, year of OLT, sex, and type of liver disease.
  
  
  RESULTS
  Chronic hepatitis C, alcohol and primary sclerosing cholangitis were the three leading causes of liver disease. Skin cancer was the most common malignancy (32%), followed by gastrointestinal (21%), including five small bowel tumors, and hematologic malignancies (17%). The cases and controls were not significantly different in the immunosuppressive regimen (p = 0.42) or the number of rejection episodes (p = 0.92). The five- and 10-year Kaplan-Meier survival rates for the cases were 77% and 34%, respectively, vs. 84% and 70%, respectively, for the controls (p = 0.02 by log-rank test). Patients with skin cancers had survival similar to the controls, but significantly better than non-skin cancers (p = 0.0001). The prognosis for patients with gastrointestinal tumors was poor, with a median survival of 8.5 months after the diagnosis.
  
  
  CONCLUSIONS
  In this single institutional study, de novo malignancies after OLT were uncommon. Patients with non-skin cancer after OLT had diminished long-term survival compared with the controls. Our results differ from other reports in the high incidence of gastrointestinal malignancies with attendant poor prognosis.
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0538, USA.
authors.forename: Francis Y
authors.initials: FY
authors.lastname: Yao
authors.forename: Manjushree
authors.initials: M
authors.lastname: Gautam
authors.forename: Caren
authors.initials: C
authors.lastname: Palese
authors.forename: Raquel
authors.initials: R
authors.lastname: Rebres
authors.forename: Norah
authors.initials: N
authors.lastname: Terrault
authors.forename: John P
authors.initials: JP
authors.lastname: Roberts
authors.forename: Marion G
authors.initials: MG
authors.lastname: Peters
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications; D016022:Case-Control Studies; D015209:Cholangitis, Sclerosing / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000209:etiology; D019698:Hepatitis C, Chronic / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology* / Q000401:mortality; D011183:Postoperative Complications; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000209:etiology; D015996:Survival Rate