Burden of de novo malignancy in the liver transplant recipient.
Recipients of liver transplantation (LT) have a higher overall risk (2-3 times on average) of developing de novo malignancies than the general population, with standardized incidence ratios ranging from 1.0 for breast and prostate cancers to 3-4 for colon cancer and up to 12 for esophageal and oropharyngeal cancers. Aside from immunosuppression, other identified risk factors for de novo malignancies include the patient's age, a history of alcoholic liver disease or primary sclerosing cholangitis, smoking, and viral infections with oncogenic potential. Despite outcome studies showing that de novo malignancies are major causes of mortality and morbidity after LT, there are no guidelines for cancer surveillance protocols or immunosuppression protocols to lower the incidence of de novo cancers. Patient education, particularly for smoking cessation and excess sun avoidance, and regular clinical follow-up remain the standard of care. Further research in epidemiology, risk factors, and the effectiveness of screening and management protocols is needed to develop evidence-based guidelines for the prevention and treatment of de novo malignancies.
Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada.
Natasha
N
Chandok
Kymberly D
KD
Watt
D005260:Female; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016031:Liver Transplantation / Q000379:methods*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis; D008297:Male; D008495:Medical Oncology / Q000379:methods; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications; D012307:Risk Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents