Nationwide population-based study reveals increased malignancy risk in taiwanese liver transplant recipients.
Post-transplant malignancy is a major cause of late mortality for liver transplant recipients (LTRs). This nationwide population-based cohort study investigated the cancer type, incidence, and risk factors associated with post-transplant malignancies in 2938 Taiwanese LTRs who underwent transplantation between 1998 and 2012. Data from the National Health Insurance Research Database were extracted on the basis of the International Classification of Disease, Ninth Revision, Clinical Modification codes. Among these patients, 284 post-transplant malignancies were diagnosed. These included 99 de novo malignancies among 98 patients, yielding a standardized incidence ratio of 2.17 (95% CI, 1.76 to 2.64) compared to the general population. The most common malignancies were infection related liver cancer (19.39%), oropharyngeal cancer (19.39%), non-Hodgkin's lymphoma (9.18%), and esophageal cancer (5.10%), as well as non-infection-related prostate cancer (6.12%). Patients with recurrent malignancies had the highest mortality. Furthermore, 186 recurrent malignancies relapsed, and the commonly affected organs were the liver (83.33%), lung (4.84%), bone and bone marrow (4.30%), and intrahepatic bile ducts (2.69%). Old age, the male sex, liver cirrhosis, hepatitis B, peptic ulcer, diabetes mellitus, and pre-existing cancer were all risk factors associated with post-transplant malignancies. Recipients with biliary atresia or urea cycle metabolism disorders were protected from post-transplant malignancies. Our data revealed a significantly increased risk of malignancies in Taiwanese LTRs and suggest implementation of a careful malignancy-surveillance program and immunosuppression-minimizing strategy for high-risk patients.
Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Yung Fong
YF
Tsai
Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Hsiu Pin
HP
Chen
Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Fu Chao
FC
Liu
Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan.
Shih Hao
SH
Liu
Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Chun Yu
CY
Chen
Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Chih Wen
CW
Cheng
Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan.
Jr-Rung
JR
Lin
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D007166:Immunosuppressive Agents
de novo malignancy; immunosuppression; mortality; post-transplant malignancy; recurrent malignancy