Recurrent Nonhepatic and De Novo Malignancies After Liver Transplantation

Introduction: After Liver transplantation (LTx), recurrence of hepatic cancer, de novo cancers, and donor-transmitted cancers have been described. However, the data for patients with a prior history of nonhepatic malignancy and its recurrence post-LTx are limited.

Aim: Aim of this study was to examine the patient with nonhepatic pre-LTx malignancies, and their recurrence post-LTx along with de novo cancers and recurrence of hepatic malignancy in the population.

Patients And Method: Between March 1996 and July 2006, 1127 patients underwent LTx at our institution. Thirty patients (2.7%) (15 men and 15 women, mean age 56.9+/-12.8 years) had documented nonhepatic malignancies. There were seven colorectal, three prostatic, three cervical, three bladder, six breast, and other nine miscellaneous cancers (one patient had two cancers). Four patients had hepatocellular carcinoma at the time of LTx. All patients were followed up until 2008 with a mean follow-up period of 34.1+/-35.3 months.

Results: One patient with oropharyngeal cancer (3.3%), who was recurrence-free pre-LTx for 77.3 months, developed recurrence 36 months post-LTx and subsequently died 11 months postrecurrence. Two patients developed de novo cancer. One developed renal cell carcinoma 46.6 months post-LTx and other developed de novo intra-abdominal metastatic adenocarcinoma of unknown origin. Three of four patients developed recurrent hepatocellular carcinoma.

Conclusion: The rate of recurrence of nonhepatic malignancy was 3% and de novo cancer was 6% in the present series. There is a need to develop a guideline for recurrence-free survival period for nonhepatic malignancies before LTx, based on the type and stage of cancer.