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Cancer in liver transplant recipients: Management and outcomes
Author(s) -
Martin Hilary L,
Chen John WC,
Koczwara Bogda
Publication year - 2013
Publication title -
asia‐pacific journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 29
eISSN - 1743-7563
pISSN - 1743-7555
DOI - 10.1111/ajco.12041
Subject(s) - medicine , chemotherapy , immunosuppression , malignancy , cancer , liver transplantation , oncology , chemoradiotherapy , transplantation , surgery , intensive care medicine
Aim To investigate the management and cancer outcomes of liver transplant recipients. Method An audit of all liver transplant recipients from a single liver transplant center from J anuary 1991 to M arch 2010. Data were obtained from case notes, cancer registry and clinical databases. Results 198 transplant recipients were identified and 49 (25%) were confirmed as having post‐transplantation malignancies. Of these 32 (16%) patients developed skin malignancies and 17 (9%) developed post‐transplant non‐skin malignancies. All skin malignancies had local involvement only and none of the patients with skin malignancies developed nodal or distant metastases. All were managed with local treatment. Of those with non‐cutaneous malignancies, four were managed with local therapy alone, two with immunosuppression reduction, seven with chemotherapy, including two with chemoradiotherapy, one with a targeted agent and three with supportive care only. None of the patients who were treated with chemotherapy for non‐skin malignancies were able to complete the full prescribed dose of chemotherapy as a result of chemotherapy‐related toxicities. Of those treated with chemotherapy one died of hepatic failure and one of chemotherapy‐related infection. Conclusion Liver transplant recipients are at high risk of cancer. Outcomes for liver transplant recipients with post‐transplant malignancy are excellent if detected when they are amenable to local therapy alone. Outcomes are poor, with high rates of treatment‐associated toxicity, in patients who require systemic therapy. Further research is required to enable the development of guidelines for the safe administration of systemic treatment in this group.