Long-term probability of and mortality from de novo malignancy after liver transplantation.
Long-term probability of and mortality from de novo malignancy after liver transplantation.
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DOI：
10.1053/j.gastro.2009.08.070
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发表时间：
2009-12
期刊：
影响因子：
29.4
通讯作者：
Gores GJ
中科院分区：
文献类型：
--
作者：
Watt KD;Pedersen RA;Kremers WK;Heimbach JK;Sanchez W;Gores GJ
Information about malignancies that arise in patients after liver transplantation comes from volunteer registry databases and single-center retrospective studies. We analyzed a multi-center, prospectively obtained database to assess the probabilities of and risk factors for de novo malignancies in patients after liver transplantation. We analyzed the National Institute of Diabetes and Digestive and Kidney Diseases’s Liver Transplantation Database of 798 adults that received transplants from April 1990 to June 1994 and long-term follow-up data through January 2003. In this patient population, 171 adult patients developed 271 de novo malignancies. Of these malignancies, 147 were skin related, 29 were hematologic, and 95 were solid organ cancers; we focused on non-skin malignancies. The probability of developing any non-skin malignancy was highest in patients with primary sclerosing cholangitis (PSC, 22% at 10 years) or alcohol-related liver disease (ALD, 18% at 10 years); all other diagnoses had a 10% probability. Multivariate analysis indicated that increased age by decade (hazard ratio [HR] 1.33, p=0.01), a history of smoking (HR 1.6, p=0.046), PSC (HR 2.5, p=0.001), and ALD (HR 2.1, p=0.01) were associated with the development of solid malignancies after liver transplantation. The probabilities of death after diagnosis of hematologic and solid malignancy ere 44.0% and 38.0% at one year and 57.6% and 53.1% at 5 years, respectively. De novo malignancy primarily affects patients with PSC or ALD, compared to other transplant recipients, with a significant impact on long-term survival.
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