Service d'hépatologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
Clin Transplant. 2024 Oct;38(11):e70014. doi: 10.1111/ctr.70014.
De novo malignancies are one of the leading causes of death after liver transplantation (LT), particularly in patients transplanted for alcohol-related liver disease (ALD). This retrospective study aimed to assess risk factors for malignancies and to evaluate the impact of calcineurin inhibitor (CNI) discontinuation.
From 1990 to 2015, all patients transplanted for ALD were included.
A total of 493 patients were included, 77.9% were male and the median age at LT was 54 years. After LT, 278 de novo malignancies were diagnosed in 214 patients (43.4%). The cumulative incidence of de novo malignancies was 16.3% at 5 years, 34.4% at 10 years, and 49.8% at 15 years. In multivariate analysis, the independent risk factors were male gender (HR = 1.6), and active or weaned smoking (HR = 2.0). Discontinuation of CNI was a protective factor (HR = 0.6). Survival after diagnosis of de novo malignancy was 42.7% at 5 years and 27.5% at 10 years.
Our results confirm the major incidence of de novo malignancies after LT for ALD, as well as the important role of non-modifiable risk factors such as smoking and gender. CNI discontinuation is a protective factor, and the only adaptable, and could be proposed in smoker male patients transplanted for ALD.
肝移植（LT）后新发恶性肿瘤是导致死亡的主要原因之一，尤其是在因酒精性肝病（ALD）而接受移植的患者中。本回顾性研究旨在评估恶性肿瘤的危险因素，并评估钙调神经磷酸酶抑制剂（CNI）停药的影响。
1990 年至 2015 年，所有因 ALD 接受移植的患者均被纳入研究。
共纳入 493 例患者，77.9%为男性，LT 时的中位年龄为 54 岁。LT 后，214 例患者中有 278 例诊断为新发恶性肿瘤（43.4%）。新发恶性肿瘤的累积发生率为 5 年时 16.3%，10 年时 34.4%，15 年时 49.8%。多因素分析显示，独立的危险因素为男性（HR=1.6）和正在吸烟或已戒烟（HR=2.0）。CNI 停药是保护因素（HR=0.6）。诊断为新发恶性肿瘤后的 5 年生存率为 42.7%，10 年生存率为 27.5%。
我们的研究结果证实了 LT 后因 ALD 而发生新发恶性肿瘤的高发生率，以及吸烟和性别等不可改变的危险因素的重要作用。CNI 停药是一种保护因素，且为唯一可调整的因素，可向因 ALD 接受移植的男性吸烟者提出。
