De Novo Malignancy After Living Donor Liver Transplantation: A Large Volume Experience

Anisha Tiwari; Sanjiv Saigal; Narendra S Choudhary; Sujeet Saha; Amit Rastogi; Prashant Bhangui; Neeraj Saraf; Thiagrajan Srinivasan; Sanjay K Yadav; Dheeraj Gautam; Samiran Nundy; Arvinder S Soin

doi:10.1016/j.jceh.2020.02.001

De Novo Malignancy After Living Donor Liver Transplantation: A Large Volume Experience

J Clin Exp Hepatol. 2020 Sep-Oct;10(5):448-452. doi: 10.1016/j.jceh.2020.02.001. Epub 2020 Feb 13.

Affiliations

¹ Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurugram, India.
² Department of Histopathology, Medanta The Medicity, Gurugram, India.
³ Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India.

Abstract

Background and aims: Liver transplantation (LT) recipients such as all organ transplant recipients, have a risk of developing de novo malignancies owing to prolonged immunosuppression. However, there is limited data on this after living donor liver transplantation (LDLT), wherein immunosuppression levels are less than in deceased donor transplantation. We aim to describe experience of de novo malignancies from a predominantly LDLT center.

Materials and methods: A total of 2100 adults (age >18 years) who underwent LT between January 2006 and December 2017 were retrospectively analyzed from a prospectively collected database. The data were analyzed up to June 2019. Data are shown as number, percentage, mean ± standard deviation, and median (interquartile range).

Results: Of 2100 patients who underwent LDLT, 21 (1%) patients developed de novo malignancy after transplantation. The de novo malignancy cohort comprised 20 males and 1 female, aged 50 ± 8.8 years. The distribution of de novo malignancies was as follows: 7 oropharyngeal (carcinoma of buccal and oral mucosa), 4 lung, 2 squamous cell carcinoma of skin, 2 lymphoma, 1 each of brain, colonic, gastric; ovary, pancreatic, and prostate. These malignancies were diagnosed at a median follow-up of 42 months (32-73) after LT. Over a median follow-up of 38 months (10-56) after the diagnosis of de novo malignancy, 6 patients (28.5%) died. Patients with de novo malignancy had a higher follow-up after LDLT, 94.3 ± 32.9 versus 62.5 ± 41.8 months, P = 0.000. Patients with alcohol as etiology for LT had higher trend of de novo malignancies (33.3% versus 26.4%), P = 0.46.

Conclusion: The incidence of de novo malignancy was 1% at a median follow-up of 42 (32-73) months. De novo malignancies following LDLT, although uncommon, are associated with significant mortality. A careful screening protocol should be followed after transplantation for early detection of de novo malignancies.

Keywords: LDLT, Living Donor Liver Transplantation; LT, Liver Transplantation; MMF, Mycophenolate mofetil; Tac, Tacrolimus; alcohol; immunosuppression; liver transplantation; mTOR, Mammalian target of rapamycin; malignancy.