title: Incidence, risk factors and outcome of de novo tumors in liver transplant recipients focusing on alcoholic cirrhosis.
abstract: Orthotopic liver transplantation (OLT) is an established life-saving procedure for alcoholic cirrhotic (AC) patients, but the incidence of de novo tumors ranges between 2.6% and 15.7% and is significantly increased in comparison with patients who undergo OLT for other etiologies. Tobacco, a known carcinogen, has been reported to be between 52% and 83.3% in AC patients before OLT. Other risk factors that contribute to the development of malignancies are dose-dependent immunosuppression, advanced age, viral infections, sun exposure, and premalignant lesions (inflammatory bowel disease, Barrett's esophagus). A significantly more frequent incidence of upper aerodigestive (UAD) tract, lung, skin, and kidney-bladder tumors has been found in OLT recipients for AC in comparison with other etiologies. Liver transplant recipients who develop de novo non-skin tumors have a decreased long-term survival rate compared with controls. This significantly lower survival rate is more evident in AC recipients who develop UAD tract or lung tumors after OLT mainly because the diagnosis is usually performed at an advanced stage. All transplant candidates, especially AC patients, should be encouraged to cease smoking and alcohol consumption in the pre- and post-OLT periods, use skin protection, avoid sun exposure and over-immunosuppression, and have a yearly otopharyngolaryngeal exploration and chest computed tomography scan in order to prevent or reduce the incidence of de novo malignancies. Although still under investigation, substitution of calcineurin inhibitors for sirolimus or everolimus may reduce the incidence of de novo tumors after OLT.
authors.affiliation: Carlos Jiménez-Romero, Iago Justo-Alonso, Félix Cambra-Molero, Jorge Calvo-Pulido, Álvaro García-Sesma, Manuel Abradelo-Usera, Oscar Caso-Maestro, Alejandro Manrique-Municio, Service of General and Digestive Surgery, Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, Universidad Complutense de Madrid, 28041 Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Jiménez-Romero
authors.affiliation: Carlos Jiménez-Romero, Iago Justo-Alonso, Félix Cambra-Molero, Jorge Calvo-Pulido, Álvaro García-Sesma, Manuel Abradelo-Usera, Oscar Caso-Maestro, Alejandro Manrique-Municio, Service of General and Digestive Surgery, Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, Universidad Complutense de Madrid, 28041 Madrid, Spain.
authors.forename: Iago
authors.initials: I
authors.lastname: Justo-Alonso
authors.affiliation: Carlos Jiménez-Romero, Iago Justo-Alonso, Félix Cambra-Molero, Jorge Calvo-Pulido, Álvaro García-Sesma, Manuel Abradelo-Usera, Oscar Caso-Maestro, Alejandro Manrique-Municio, Service of General and Digestive Surgery, Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, Universidad Complutense de Madrid, 28041 Madrid, Spain.
authors.forename: Félix
authors.initials: F
authors.lastname: Cambra-Molero
authors.affiliation: Carlos Jiménez-Romero, Iago Justo-Alonso, Félix Cambra-Molero, Jorge Calvo-Pulido, Álvaro García-Sesma, Manuel Abradelo-Usera, Oscar Caso-Maestro, Alejandro Manrique-Municio, Service of General and Digestive Surgery, Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, Universidad Complutense de Madrid, 28041 Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Calvo-Pulido
authors.affiliation: Carlos Jiménez-Romero, Iago Justo-Alonso, Félix Cambra-Molero, Jorge Calvo-Pulido, Álvaro García-Sesma, Manuel Abradelo-Usera, Oscar Caso-Maestro, Alejandro Manrique-Municio, Service of General and Digestive Surgery, Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, Universidad Complutense de Madrid, 28041 Madrid, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: García-Sesma
authors.affiliation: Carlos Jiménez-Romero, Iago Justo-Alonso, Félix Cambra-Molero, Jorge Calvo-Pulido, Álvaro García-Sesma, Manuel Abradelo-Usera, Oscar Caso-Maestro, Alejandro Manrique-Municio, Service of General and Digestive Surgery, Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, Universidad Complutense de Madrid, 28041 Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Abradelo-Usera
authors.affiliation: Carlos Jiménez-Romero, Iago Justo-Alonso, Félix Cambra-Molero, Jorge Calvo-Pulido, Álvaro García-Sesma, Manuel Abradelo-Usera, Oscar Caso-Maestro, Alejandro Manrique-Municio, Service of General and Digestive Surgery, Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, Universidad Complutense de Madrid, 28041 Madrid, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Caso-Maestro
authors.affiliation: Carlos Jiménez-Romero, Iago Justo-Alonso, Félix Cambra-Molero, Jorge Calvo-Pulido, Álvaro García-Sesma, Manuel Abradelo-Usera, Oscar Caso-Maestro, Alejandro Manrique-Municio, Service of General and Digestive Surgery, Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, Universidad Complutense de Madrid, 28041 Madrid, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Manrique-Municio
keywords: Alcoholic cirrhosis; De novo cancer; De novo malignancies; De novo tumors tobacco consumption; Liver transplant