Multiorgan Transplant Program, University Health Network, Toronto, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Transplantation. 2019 Jan;103(1):91-100. doi: 10.1097/TP.0000000000002113.
Malignancy after liver transplant (LT) is a leading cause of mortality, but data is limited. The aim of this study was to identify patients at higher risk for de novo malignancies after LT in a large multicenter database.
The Scientific Registry of Transplant Recipients database comprising all 108 412 LT recipients across the United States between 1987 and March 2015 was analyzed with a median follow-up of 6.95 years. Potential risk factors for malignancies after LT were assessed using Cox regression analysis for the outcome of time to first malignancy.
Mean age 51.9 ± 10.8 years, 64.6% male, 74.5% white, and 15.8% with previous malignancy. Malignancies during follow-up were 4,483 (41.3%) skin, 1519 (14.0%) hematologic, and 4842 (44.7%) solid organ. The 10-year probability of de novo malignancy was 11.5% (11.3-11.8%). On multivariable analysis, age by decade (hazard ratio [HR], 1.52; P < 0.001), male sex (HR, 1.28; P < 0.001), white race (compared with other races: HR, 1.45-2.04; P < 0.001), multiorgan transplant (HR, 1.35; P < 0.001), previous malignancy (HR, 1.34; P < 0.001), and alcoholic liver disease, autoimmune, nonalcoholic steatohepatitis (HR, 1.35; P < 0.001), and primary sclerosing cholangitis pre-LT (compared with hepatitis C virus, P < 0.001) were associated with higher risk of post-LT malignancy, but type of immunosuppression was not (P = NS).
This large data set demonstrates the effects of ethnicity/race and etiologies of liver disease, particularly nonalcoholic steatohepatitis as additional risk factors for cancer after LT. Patients with these high-risk characteristics should be more regularly and diligently screened.
肝移植（LT）后的恶性肿瘤是导致死亡的主要原因，但相关数据有限。本研究的目的是在一个大型多中心数据库中确定 LT 后新发恶性肿瘤风险较高的患者。
分析了美国 1987 年至 2015 年 3 月期间 108412 例 LT 受者的科学移植受者登记处数据库，中位随访时间为 6.95 年。使用 Cox 回归分析评估 LT 后恶性肿瘤的潜在危险因素。
平均年龄 51.9±10.8 岁，64.6%为男性，74.5%为白人，15.8%有既往恶性肿瘤。随访期间发生恶性肿瘤 4483 例（41.3%）为皮肤，1519 例（14.0%）为血液系统，4842 例（44.7%）为实体器官。10 年新发恶性肿瘤的概率为 11.5%（11.3-11.8%）。多变量分析显示，年龄每十年增加一个阶段（风险比[HR]，1.52；P<0.001），男性（HR，1.28；P<0.001），白种人（与其他种族相比：HR，1.45-2.04；P<0.001），多器官移植（HR，1.35；P<0.001），既往恶性肿瘤（HR，1.34；P<0.001），酒精性肝病、自身免疫性疾病、非酒精性脂肪性肝炎（HR，1.35；P<0.001）和原发性硬化性胆管炎 LT 前（与丙型肝炎病毒相比，P<0.001）与 LT 后恶性肿瘤风险增加相关，但免疫抑制类型无相关性（P=NS）。
该大型数据集显示了种族/民族和肝病病因的影响，特别是非酒精性脂肪性肝炎是 LT 后癌症的另一个危险因素。具有这些高危特征的患者应更定期和更认真地进行筛查。
