De novo malignancies after liver transplantation: a single-center experience.
OBJECTIVE
The recipients of liver transplantation (LT) are subjected to lifelong immunosuppression with its many drawbacks. De novo and recurrent malignancy in transplant recipients are attributed to attenuation of immunosurveillance. In the present study, we present our experience with de novo malignancies encountered after both deceased and living donor liver transplantations.


METHODS
Retrospective study of patients referred to LT center between April 2001 and January 2010.


METHODS
Various data were collected including type of malignancy and histopathologic features, immunosuppression regimen, and patient survival.


RESULTS
Of 248 LT procedures performed in 238 patients (10 retransplants), 8 patients (3.4%) developed de novo post-LT malignancies. De novo malignancies included post-LT lymphoproliferative disorders (PTLD) in 5 patients who were all Epstein-Barr virus (EBV) positive, and who were treated successfully with anti-CD20 monoclonal antibody therapy, reduction of immunosuppression, and control of EBV activity; urinary bladder cancer in 1 patient who was treated with radical surgical resection and chemotherapy but died of bone and lung metastasis within 1 year of diagnosis; endometrial carcinoma in 1 patient who was treated with radical surgical resection; and Kaposi sarcoma in 1 patient who was successfully treated with surgical excision and reduction of immunosuppression.


CONCLUSIONS
EBV-associated PTLD is the most frequently encountered de novo malignancy after LT and is easily treatable by chemotherapy and reduction of immunosuppression.
Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center,Riyadh, Saudi Arabia. b_hegab@yahoo.com
Bassem
B
Hegab
Hatem
H
Khalaf
Naglaa
N
Allam
Ayman
A
Azzam
Faisal Aba
FA
Al Khail
Waleed
W
Al-hamoudi
Yasser
Y
Kamel
Hamad
H
Al Bahili
Mohammed
M
Al Sofayan
Mohammed
M
Al-Sebayel
D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018951:Antigens, CD20 / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000209:etiology; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D007223:Infant; D016031:Liver Transplantation / Q000379:methods*; D008232:Lymphoproliferative Disorders / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
D000911:Antibodies, Monoclonal; D018951:Antigens, CD20; D007166:Immunosuppressive Agents