Metabolic syndrome before liver transplantation: does it have an impact on post liver transplantation outcome?

Introduction: metabolic syndrome (MS) and cardiovascular risk factors are common in liver transplant (LT) candidates and recipients. Cardiovascular events and de novotumors are increasingly common causes of mortality inliver transplant recipients. The aims of this study were i)to assess the prevalence of MS in LT recipients and itsgrowth over the years, and ii) to determine if the presenceof MS pre-LT is associated with a higher risk of post-LTcardiovascular events (CVE), de novo tumors, or early andlate survival.Patients and methods: a retrospective study was performedthat included LT recipients from January 2012 to December2017. Baseline features (MS before LT and at 1year post-LT)and outcomes (CVE, de novo tumors and survival) wererecorded. Results: a total of 483 recipients were included, MS waspresent in 20 % of pre-LT subjects with an increasingprevalence over time, from 16 % in 2012 to 34 % in 2017(p = 0.025). One-year post-LT, an additional 12 % had developed de novo MS. At a median of 56 months of follow-up,13 % developed a CVE and 9 % a de novo tumor. One and5-year survival rates were 91 % and 83 % in those with preLT MS, and 93 % and 85 % in those without it (p = 0.94). Thepresence of MS before LT was independently associatedwith a higher risk of post-LT CVE (HR: 2.66, 95 % CI: 1.6-4.4,p < 0.001) but not with de novo tumors (p = 0.94) nor earlyand late survival (p = 0.58 and p = 0.87).Conclusion: pre-LT MS is increasing among LT candidatesand is associated with a higher risk of post-LT morbidity(CVE) yet without affecting mortality. (AU)

De novo multiple primary carcinomas in a patient after liver transplantation: A case report.

BACKGROUND: Liver transplantation (LT) is the most effective treatment strategy for advanced liver diseases. With the increasing survival rate and prolonged survival time, the postoperative long-term complications of LT recipients are becoming an important concern. Among them, the newly developed cancer after LT is the second complication and cause of LT-related death after cardiovascular disease. At present, few papers have reported multiple primary carcinomas (MPCs) after LT. Herein, we retrospectively analyzed an MPC case with gastric cancer and lung cancer after LT. CASE SUMMARY: Herein, we retrospectively analyzed an MPC case with de novo gastric cancer and lung cancer after LT with no obvious complaints. Forty-one months after LT, the patient underwent radical distal gastrectomy (Billroth II) for intramucosal signet ring cell carcinoma, and then thoracoscopic wedge resection of the right lower lobe of the right lung and localized lymph node dissection 2 mo later. Therefore, paying attention to follow-up in LT recipients with early detection and intervention of de novo MPCs is the key to improving the survival rate and quality of life of LT recipients. CONCLUSION: De novo MPCs after LT are rare, and the prognosis is poorer. However, early detection and related intervention can significantly improve the prognosis of patients. Therefore, we recommend that liver transplant recipients should be followed and screened for newly developed malignant tumors to improve the survival rate and quality of life.

Incidence, risk factors and outcome of de novo tumors in liver transplant recipients focusing on alcoholic cirrhosis.

Orthotopic liver transplantation (OLT) is an established life-saving procedure for alcoholic cirrhotic (AC) patients, but the incidence of de novo tumors ranges between 2.6% and 15.7% and is significantly increased in comparison with patients who undergo OLT for other etiologies. Tobacco, a known carcinogen, has been reported to be between 52% and 83.3% in AC patients before OLT. Other risk factors that contribute to the development of malignancies are dose-dependent immunosuppression, advanced age, viral infections, sun exposure, and premalignant lesions (inflammatory bowel disease, Barrett's esophagus). A significantly more frequent incidence of upper aerodigestive (UAD) tract, lung, skin, and kidney-bladder tumors has been found in OLT recipients for AC in comparison with other etiologies. Liver transplant recipients who develop de novo non-skin tumors have a decreased long-term survival rate compared with controls. This significantly lower survival rate is more evident in AC recipients who develop UAD tract or lung tumors after OLT mainly because the diagnosis is usually performed at an advanced stage. All transplant candidates, especially AC patients, should be encouraged to cease smoking and alcohol consumption in the pre- and post-OLT periods, use skin protection, avoid sun exposure and over-immunosuppression, and have a yearly otopharyngolaryngeal exploration and chest computed tomography scan in order to prevent or reduce the incidence of de novo malignancies. Although still under investigation, substitution of calcineurin inhibitors for sirolimus or everolimus may reduce the incidence of de novo tumors after OLT.

[De novo malignant tumors following liver transplantation. A single-center experience in Argentina]. / Tumores malignos de novo en el trasplante hepático. Experiencia de un centro en la Argentina.

The aim of the present study was to evaluate the incidence and clinical features of de novo tumors in patients undergoing liver transplantation in our center as well as to assess survival. We retrospectively analyzed 168 liver transplantations (159 patients) performed from May 2006 to May 2014. The incidence of de novo tumors was 7.5% (n = 12). The mean age at diagnosis was 63 ± 7 years. The most frequent neoplasms were non melanoma skin tumors and adenocarcinomas. Fifty percent of the tumors developed in the second and third year after transplantation. Type of immunosuppression did not influence tumoral type, although most patients receive tacrolimus in combination with mycofenolate and/or corticoids. The mean duration of follow-up after diagnosis of the tumor was 25 ± 29 months (range 0-76) and the mortality was 41%. The actuarial probability of survival at 1 and 5 years was 83 and 55%, respectively. De novo tumors are frequent after liver transplantation and their clinical course differs from that in the general population. Because their clinical course is more aggressive, regular follow up of these patients is essential for early diagnosis.

Tumores malignos de novo en el trasplante hepático experiencia de un centro en la Argentina

El objetivo del presente trabajo ha sido evaluar la incidencia y las características clínicas de los tumores aparecidos de novo en los pacientes sometidos a trasplante hepático, como así también su supervivencia. Para ello, analizamos en forma retrospectiva los 168 trasplantes hepáticos realizados en 159 pacientes adultos en el período mayo 2006 hasta mayo 2014, encontrando una incidencia de neoplasia de novo de 7.5% (n = 12). La edad media en el momento del diagnóstico fue de 63 ± 7 años. Las neoplasias más frecuentes fueron las de piel no melanoma y adenocarcinomas. El 50% de las neoplasias se desarrollaron en el segundo y tercer año postrasplante. El tipo de inmunosupresión no influyó en el tipo de tumor; sin embargo, debemos destacar que la mayor parte de los pacientes recibieron tacrolimus, micofenolato y/o corticoides. El tiempo medio de seguimiento tras el diagnóstico del tumor fue 25 ± 29 meses (0-76), y la tasa de mortalidad fue de un 41% (5/12 pacientes IC95%,15-72).La supervivencia global luego del trasplante a 1 y 5 años, calculada por análisis de Kaplan-Meier, fue de 83 y 55%, respectivamente. Los tumores de novo son frecuentes luego del trasplante hepático y presentan un patrón evolutivo diferente al de la población general. Teniendo en cuenta esta evolución más agresiva, es fundamental el seguimiento periódico en estos pacientes para realizar un diagnóstico lo más precoz posible.(AU)

The aim of the present study was to evaluate the incidence and clinical features of de novo tumors in patients undergoing liver transplantation in our center as well as to assess survival. We retrospectively analyzed 168 liver transplantations (159 patients) performed from May 2006 to May 2014. The incidence of de novo tumors was 7.5% (n = 12). The mean age at diagnosis was 63 ± 7 years. The most frequent neoplasms were non melanoma skin tumors and adenocarcinomas. Fifty percent of the tumors developed in the second and third year after transplantation. Type of immunosuppression did not influence tumoral type, although most patients receive tacrolimus in combination with mycofenolate and/or corticoids. The mean duration of follow-up after diagnosis of the tumor was 25 ± 29 months (range 0-76) and the mortality was 41%. The actuarial probability of survival at 1 and 5 years was 83 and 55%, respectively. De novo tumors are frequent after liver transplantation and their clinical course differs from that in the general population. Because their clinical course is more aggressive, regular follow up of these patients is essential for early diagnosis.(AU)

Tumores malignos de novo en el trasplante hepático experiencia de un centro en la Argentina

El objetivo del presente trabajo ha sido evaluar la incidencia y las características clínicas de los tumores aparecidos de novo en los pacientes sometidos a trasplante hepático, como así también su supervivencia. Para ello, analizamos en forma retrospectiva los 168 trasplantes hepáticos realizados en 159 pacientes adultos en el período mayo 2006 hasta mayo 2014, encontrando una incidencia de neoplasia de novo de 7.5% (n = 12). La edad media en el momento del diagnóstico fue de 63 ± 7 años. Las neoplasias más frecuentes fueron las de piel no melanoma y adenocarcinomas. El 50% de las neoplasias se desarrollaron en el segundo y tercer año postrasplante. El tipo de inmunosupresión no influyó en el tipo de tumor; sin embargo, debemos destacar que la mayor parte de los pacientes recibieron tacrolimus, micofenolato y/o corticoides. El tiempo medio de seguimiento tras el diagnóstico del tumor fue 25 ± 29 meses (0-76), y la tasa de mortalidad fue de un 41% (5/12 pacientes IC95%,15-72).La supervivencia global luego del trasplante a 1 y 5 años, calculada por análisis de Kaplan-Meier, fue de 83 y 55%, respectivamente. Los tumores de novo son frecuentes luego del trasplante hepático y presentan un patrón evolutivo diferente al de la población general. Teniendo en cuenta esta evolución más agresiva, es fundamental el seguimiento periódico en estos pacientes para realizar un diagnóstico lo más precoz posible.

The aim of the present study was to evaluate the incidence and clinical features of de novo tumors in patients undergoing liver transplantation in our center as well as to assess survival. We retrospectively analyzed 168 liver transplantations (159 patients) performed from May 2006 to May 2014. The incidence of de novo tumors was 7.5% (n = 12). The mean age at diagnosis was 63 ± 7 years. The most frequent neoplasms were non melanoma skin tumors and adenocarcinomas. Fifty percent of the tumors developed in the second and third year after transplantation. Type of immunosuppression did not influence tumoral type, although most patients receive tacrolimus in combination with mycofenolate and/or corticoids. The mean duration of follow-up after diagnosis of the tumor was 25 ± 29 months (range 0-76) and the mortality was 41%. The actuarial probability of survival at 1 and 5 years was 83 and 55%, respectively. De novo tumors are frequent after liver transplantation and their clinical course differs from that in the general population. Because their clinical course is more aggressive, regular follow up of these patients is essential for early diagnosis.