title: Evolution and management of de novo neoplasm post-liver transplantation: a 20-year experience from a single European centre.
abstract: OBJECTIVE
  Survival post-liver transplantation (LT) has improved; however, patients are considered at the, risk of malignancy due to prolonged immunosuppression. The long-term outcome of patients developing de novo neoplasm (DN) at our centre was evaluated.
  
  
  METHODS
  Between October 1988 and December 2007, 800 LT were performed in 742 patients. Patients were divided into two study periods according to the time of LT; first: October 1988-December 1995; second: January 1996-December 2007.
  
  
  RESULTS
  After a mean follow-up of 5 ± 4.6 years, 71 DN (9.5%) were detected in 742 patients. The cumulative risk of DN development increased with the time from LT although no differences at 3, 5, and 10 years were found when first and second periods were compared (3, 7, 16% vs. 2, 4, 11%, respectively; p = 0.4). DN incidence was higher in the first compared with the second period (10.7 vs. 7.8%; p < 0.04); no significant differences were observed in mortality rate (50 vs. 27%; p = 0.052). Actuarial patient survival post-DN at 1, 3, and 5 years: 67, 48, 45% versus 82, 71, 65%, in the first versus second period, respectively, p < 0.04.
  
  
  CONCLUSIONS
  DN incidence has decreased in recent years; however, as survival post-LT increases, so does the incidence of DN. Surveillance programmes are necessary to diagnose DN at early stages.
authors.affiliation: Department of Hepatobiliopancreatic Surgery and Transplantation, Hospital Universitario Vall D'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain, sapisochin@me.com.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Sapisochin
authors.forename: Itxarone
authors.initials: I
authors.lastname: Bilbao
authors.forename: Cristina
authors.initials: C
authors.lastname: Dopazo
authors.forename: Luis
authors.initials: L
authors.lastname: Castells
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Lázaro
authors.forename: Roberto
authors.initials: R
authors.lastname: Rodríguez
authors.forename: Mireia
authors.initials: M
authors.lastname: Caralt
authors.forename: Laia
authors.initials: L
authors.lastname: Blanco
authors.forename: Joaquin
authors.initials: J
authors.lastname: Balsells
authors.forename: Ramón
authors.initials: R
authors.lastname: Charco