Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt.
Department of Hepatology, College of Medicine, Mansoura University, Egypt.
Transplant Proc. 2021 Mar;53(2):636-644. doi: 10.1016/j.transproceed.2021.01.033. Epub 2021 Feb 3.
De novo malignancies are a major reason of long-term mortalities after liver transplantation. However, they usually receive minimal attention from most health care specialists. The current study aims to evaluate our experience of de novo malignancies after living-donor liver transplantation (LDLT).
We reviewed the data of patients who underwent LDLT at our center during the period between May 2004 and December 2018.
During the study period, 640 patients underwent LDLT. After a mean follow-up period of 41.2 ± 25.8 months, 15 patients (2.3%) with de novo malignancies were diagnosed. The most common de novo malignancies were cutaneous cancers (40%), post-transplantation lymphoproliferative disorders (13.3%), colon cancers (13.3%), and breast cancers (13.3%). Acute cellular rejection (ACR) episodes occurred in 10 patients (66.7%). Mild ACR occurred in 8 patients (53.3%), and moderate ACR occurred in 2 patients (13.3%). All patients were managed with aggressive cancer treatment. The mean survival after therapy was 40.8 ± 26.4 months. The mean overall survival after LDLT was 83.9 ± 52.9 months. Twelve patients (80%) were still alive, and 3 mortalities (20%) occurred. The 1-, 5-, and 10-year overall survival rates after LDLT were 91.7%, 91.7%, and 61.1%, respectively. On multivariate regression analysis, smoking history, operation time, and development of ACR episodes were significant predictors of de novo malignancy development.
Liver transplant recipients are at high risk for the development of de novo malignancies. Early detection and aggressive management strategies are essential to improving the recipients' survival.
新发恶性肿瘤是肝移植后长期死亡的主要原因。然而，它们通常很少受到大多数医疗保健专家的关注。本研究旨在评估我们在活体肝移植（LDLT）后新发恶性肿瘤的经验。
我们回顾了 2004 年 5 月至 2018 年 12 月期间在我们中心接受 LDLT 的患者数据。
在研究期间，640 名患者接受了 LDLT。在平均 41.2±25.8 个月的随访后，诊断出 15 例（2.3%）新发恶性肿瘤患者。最常见的新发恶性肿瘤是皮肤癌（40%）、移植后淋巴组织增生性疾病（13.3%）、结肠癌（13.3%）和乳腺癌（13.3%）。10 例（66.7%）患者发生急性细胞排斥反应（ACR）。8 例（53.3%）为轻度 ACR，2 例（13.3%）为中度 ACR。所有患者均接受了积极的癌症治疗。治疗后的平均生存时间为 40.8±26.4 个月。LDLT 后的平均总生存时间为 83.9±52.9 个月。12 例（80%）患者仍存活，3 例（20%）死亡。LDLT 后 1、5 和 10 年的总生存率分别为 91.7%、91.7%和 61.1%。多变量回归分析显示，吸烟史、手术时间和 ACR 发作的发展是新发恶性肿瘤发生的显著预测因素。
肝移植受者发生新发恶性肿瘤的风险较高。早期发现和积极的管理策略对于提高受者的生存率至关重要。
