Duvoux C, Delacroix I, Richardet J P, Roudot-Thoraval F, Métreau J M, Fagniez P L, Dhumeaux D, Cherqui D
Liver Transplant Unit, Hôpital Henri Mondor, Université Paris XII, Créteil, France.
Transplantation. 1999 Feb 15;67(3):418-21. doi: 10.1097/00007890-199902150-00014.
THE aim of this study was to describe the features of posttransplantation tumors observed in a series of liver transplant recipients with special reference to patients receiving a transplant for alcoholic cirrhosis.
Among 171 consecutive liver transplant recipients, 90 patients who had received a first liver allograft for cirrhosis were studied. After liver transplantation, detection of de novo malignancies was prospectively undertaken and the characteristics of the patients in whom tumors occurred were compared with those in whom tumors did not develop.
With a follow-up of 45.2+/-21.2 months, 11 tumors were observed in 90 patients (overall incidence of 12.2%). The incidence of tumors was higher in patients receiving a transplant for alcoholic cirrhosis than in patients receiving a transplant for nonalcoholic cirrhosis (26.7% vs. 5.0%, P<0.01). Squamous cell carcinoma (SCC) of the oropharynx or esophagus and posttransplant lymphoproliferative disorders were mainly observed. SCC (uvula in two cases, tongue in one case, esophagus in one case, pharynx in one case) occurred exclusively in patients transplanted for alcoholic cirrhosis (16.7% vs. 0%, P=0.001). The incidence of posttransplant lymphoproliferative disorders was similar in alcoholics and nonalcoholics (6.7% vs. 5%, NS). Survival was not influenced by the occurrence of SCC.
The incidence of oropharyngeal SCC could be high in patients receiving a transplant for alcoholic cirrhosis. This could be due to an additional effect of posttransplantation immunosuppression in patients exposed to alcohol and tobacco before transplant. Careful posttransplantation screening of oropharyngeal SCC is warranted after liver transplantation for alcoholic cirrhosis.
本研究的目的是描述一系列肝移植受者中观察到的移植后肿瘤的特征，特别提及因酒精性肝硬化接受移植的患者。
在171例连续的肝移植受者中，研究了90例因肝硬化接受首次肝移植的患者。肝移植后，前瞻性地进行新发恶性肿瘤的检测，并将发生肿瘤的患者特征与未发生肿瘤的患者特征进行比较。
随访45.2±21.2个月，90例患者中观察到11例肿瘤（总发生率为12.2%）。因酒精性肝硬化接受移植的患者肿瘤发生率高于因非酒精性肝硬化接受移植的患者（26.7%对5.0%，P<0.01）。主要观察到口咽或食管鳞状细胞癌（SCC）和移植后淋巴细胞增生性疾病。SCC（2例发生于悬雍垂，1例发生于舌，1例发生于食管，1例发生于咽）仅发生在因酒精性肝硬化接受移植的患者中（16.7%对0%，P=0.001）。酒精性和非酒精性患者移植后淋巴细胞增生性疾病的发生率相似（6.7%对5%，无显著性差异）。SCC的发生不影响生存率。
因酒精性肝硬化接受移植的患者口咽SCC的发生率可能较高。这可能是由于移植前接触酒精和烟草的患者移植后免疫抑制的额外作用。对于因酒精性肝硬化接受肝移植的患者，移植后对口咽SCC进行仔细筛查是必要的。
