title: Risk Factors and Outcomes of De Novo Cancers (Excluding Nonmelanoma Skin Cancer) After Liver Transplantation for Primary Sclerosing Cholangitis.
abstract: Patients with primary sclerosing cholangitis (PSC) may be at higher risk of malignancy after liver transplantation (LT) compared to other LT recipients. We aimed to determine the cumulative incidence of/risk factors for long-term cancer-related mortality in patients with PSC after LT.
  
  
  
  All adult patients underwent LT for PSC without cholangiocarcinoma from 1984 to 2012, with follow-up through June 2015. We estimated cumulative incidence, risk factors, and mortality from de novo malignancies after LT.
  
  
  
  Two hundred ninety-three patients were identified (mean [SD] age, 47 [12] years; 63.3% males; 2.4% smoking at LT). Over a median of 11.5 years (range, 6.4-18.6 years), 64 patients (21.8%) developed 73 nonskin cancers, including 46 solid-organ cancers (renal, 11; colorectal, 11; prostate, 7; breast, 5; pancreas, 5; ovarian/endometrial/vulvar cancers, 3; and de novo cholangiocarcinoma, 4). Twenty-two patients developed hematologic malignancies (posttransplant lymphoproliferative diseases, 18; Hodgkin disease, 2; and myelodysplastic syndrome, 2). Five patients developed melanoma. The 1-, 5-, 10-, and 20-year cumulative incidences of cancer were 2.1%, 8.6%, 18.7%, and 27%, respectively. Mortality of patients with PSC who developed cancer was higher than that of patients with PSC without cancer (hazard ratio, 2.2; P < 0.01). On multivariate analysis, recipient's age and elevated pre-LT international normalized ratio were associated with increased risk of de novo (nonskin) malignancy.
  
  
  
  The 10-year cumulative risk of cancer after LT for advanced-stage PSC was 18.7%, with posttransplant lymphoproliferative diseases, colorectal cancer, and renal cell cancer being the most common. Post-LT de novo nonskin cancer decreased overall posttransplant survival. Only recipient's age and elevated international normalized ratio at LT were associated with increased nonskin cancer risk.
authors.affiliation: 1 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. 2 Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, La Jolla, CA. 3 William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Mouchli
authors.forename: Siddharth
authors.initials: S
authors.lastname: Singh
authors.forename: Edward V
authors.initials: EV
authors.lastname: Loftus
authors.forename: Lisa
authors.initials: L
authors.lastname: Boardman
authors.forename: Jayant
authors.initials: J
authors.lastname: Talwalkar
authors.forename: Charles B
authors.initials: CB
authors.lastname: Rosen
authors.forename: Julie K
authors.initials: JK
authors.lastname: Heimbach
authors.forename: Russell H
authors.initials: RH
authors.lastname: Wiesner
authors.forename: Bashar
authors.initials: B
authors.lastname: Hasan
authors.forename: John J
authors.initials: JJ
authors.lastname: Poterucha
authors.forename: Watt D
authors.initials: WD
authors.lastname: Kymberly
mesh_terms: D000328:Adult; D015209:Cholangitis, Sclerosing / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology