De novo malignancies in liver transplanted patients: a long-term follow-up case-control study and retrospective analysis.

Liver transplant recipients have a higher risk of de novo malignancies (DNM) related mortality. Aim of this study is to identify potential predictors for DNM. We performed a retrospective recognition of 267 consecutive patients (pts) transplanted in our Center from Dec 96 to Jan 06. The pts were enrolled on the following criteria: liver procurement from cadaveric donors, no drop out, a follow-up longer than 3 yrs, no missing data in both pre-transplant pts-related and donor-related variables. UNOS 1 and 2nd LT recipient were not considered. 165 liver recipients whole/split: 126/39 were selected and stratified in a tumor-free control group TFCG, n=136, and in a de novo malignancies group DNMG, n=29. Antirejection treatment was based on steroids and calcineurin inhibitors. In the DNMG, 31 tumors were identified: hematologic 13% and 27 solid tumors 87%. Seven out of 27 were skin tumors 26%, 9 were gastrointestinal tumors 29% and others. Two pts developed double tumor: mammal ductal carcinoma and Kaposi lower arts, both followed by rhinopharynx carcinoma. The median follow-up was 74+/-36 months (range: 1-144; median: 68). The Kaplan-Meier estimator, log-rank test, and Cox regression were used for survival analysis. Logistic regression models LRM were assessed with DNM as dependent variable. Statistical analyses were carried out by using the software R (The R Foundation for Statistical Computing, Wien). No differences between TFCG and DNMG were found for donor sex/age, sex mismatch, pts sex, hepatitis virus infections, blood groups, UNOS, MELD, cold ischemia time, LT type, and antirejection treatments. A lower mean age was calculated in the TFCG 51.07+/-8.37 vs. DNMG 55.9+/-6.84 P=0.003874. The presence/absence of pre-transplant HCC for TFCGvs.DNMG was 92/44vs.12/17 P= 0.01074. The overall patient survival at 1 and 3 yrs was 95.75 and 89.09%, respectively. A higher 3yrs survival occurred in TFCGvs.DNMG 92%vs.76%; P=0.0128. The presence of DNM was a signifi cant predictor for survival in a univariate Cox model P=0.00029. In univariate LRM, patient age P=0.00561 and HCC P=0.00959 were found as independent predictor for DNM. Recipient age and pre-transplant HCC were potential predictors for DNM occurrence after LT. Long term specific follow-up is required.