title: Usefulness of a program of neoplasia surveillance in liver transplantation. A preliminary report.
abstract: De novo malignancies are frequent complications after liver transplantation. Aim of the study is to evaluate whether a surveillance program for malignancy may improve patient survival. We have compared the survival after the diagnosis of malignancy (excluding cutaneous and hepatobiliary carcinomas and lymphoproliferative disease) of patients with symptomatic or incidental malignancies with patients with neoplasia diagnosed on screening. Two hundred and eighty patients with a follow-up greater than three months were followed for a median of 77.5 months (total follow-up: 1515 patient-yr). Thirty-three patients developed 41 malignancies. When compared with general population, the entire cohort of liver transplant recipients had a significantly higher risk of malignancy (relative risk: 2.34), gastrointestinal tract (relative risk: 2.52), urological tract (relative risk: 2.94) and head and neck cancer (relative risk: 4.14), and cancer-related death (relative risk: 2.35). All nine patients diagnosed with cancer with active screening are currently alive and free of malignancy after a median follow-up of 25 months. By contrast, 18/24 patients with diagnosis of cancer prompted by symptoms or incidentally diagnosed died as a consequence of the cancer (median survival: 13.5 months). The difference in survival between both groups was significant (p = 0.002). In conclusion, a close surveillance protocol for the diagnosis of malignancy could be life-saving in liver transplant recipients.
authors.affiliation: Liver Unit, Clinica Universitaria de Navarra, Pamplona, Spain. iherrero@unav.es
authors.forename: J Ignacio
authors.initials: JI
authors.lastname: Herrero
authors.forename: Felix
authors.initials: F
authors.lastname: Alegre
authors.forename: Jorge
authors.initials: J
authors.lastname: Quiroga
authors.forename: Fernando
authors.initials: F
authors.lastname: Pardo
authors.forename: Mercedes
authors.initials: M
authors.lastname: Iñarrairaegui
authors.forename: Bruno
authors.initials: B
authors.lastname: Sangro
authors.forename: Fernando
authors.initials: F
authors.lastname: Rotellar
authors.forename: Custodia
authors.initials: C
authors.lastname: Montiel
authors.forename: Jesus
authors.initials: J
authors.lastname: Prieto
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000209:etiology*; D011159:Population Surveillance; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis