Immunosuppression increases the risk of posttransplant malignancy and it may increase posttransplant mortality.
The finding of factors related to the development of posttransplant malignancy may serve as a guide to avoid those risk factors and to develop strategies of posttransplant surveillance.
Dr Herrero and colleagues from Pamplona, Spain undertook a survey of the incidence and risk factors of malignancy in 187 consecutive liver transplant recipients surviving more than 3 months.
None of the 12 patients surviving less than 3 months had de novo neoplasia.
The researchers studied the impact of malignancy on survival in this case-controlled study.
After a median follow-up of 65 months, the research team found that 49 patients developed 63 malignancies: 25 patients had 35 cutaneous neoplasias and 27 patients had 28 noncutaneous malignancies.
The researchers noted that the 5- and 10-year actuarial rates of cutaneous neoplasia were 14 and 24% and the rates of noncutaneous neoplasia were 11 and 22%, respectively.
|Cutaneous neoplasia had no effect on survival, whereas patients with noncutaneous malignancy had a significant reduction of survival |
The research team found that risk factors for the development of cutaneous malignancy were older age and Child-Turcotte-Pugh A status.
Risk factors for the development of noncutaneous malignancy were older age, alcoholism, and smoking.
The investigators noted that cutaneous neoplasia had no effect on survival, whereas patients with noncutaneous malignancy had a significant reduction of survival.
The researchers calculated that the overall relative risk of cutaneous and noncutaneous neoplasia, as compared with the general population were 16.91 and 3.23, respectively.
The relative risk of cancer-related mortality (after excluding recurrent malignancy) was 2.93.
On performing multivariate analysis the researchers showed that noncutaneous malignancy was an independent risk factor for posttransplant mortality.
Dr Herrero concluded, "Liver transplant recipients have a higher risk of cancer-related mortality than the general population."
"This increased risk is due to the development of noncutaneous neoplasia."
"Older age, alcoholism, and smoking increase the risk of de novo noncutaneous neoplasia."