P-0144 - De novo malignancy after living donor liver transplantation

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Supportive Care
Hepatobiliary Cancers
Presenter Masahiro Shinoda
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors M. Shinoda1, T. Kuroda1, Y. Kitagawa1, O. Itano2, H. Obara1, M. Kitagao1, T. Hibi1, H. Yagi1, Y. Abe1, K. Matsubara1, Y. Katsuki1, H. Tomita1, A. Fujino1, K. Hoshino1
  • 1Surgery, Keio University School of Medicine, Tokyo/JP
  • 2Keio University, School of Medicine, Tokyo/JP

Abstract

Introduction

More than 25 years has passed since the first case of living donor liver transplantation (LDLT). Frequencies of de novo malignancy development after LDLT have not been fully described. We assessed incidences of de novo malignancy after LDLT in our hospital.

Methods

Since 1995, we have performed 205 cases of LDLT (120 adults and 85 children). There were 61 males and 59 females in adult cases and 40 males and 45 females in pediatric cases. There were 68 cases of biliary atresia (BA), 33 cases of hepatitis C liver cirrhosis, 31 cases of acute liver failure, 22 cases of primary biliary cirrhosis, 10 cases of hepatitis B liver cirrhosis, 10 cases of alcoholic liver cirrhosis, and 31 cases of others. Median follow-up time is 83.3 months and 90.4 months in adult and pediatric cases, respectively. We assessed incidences of post-transplant lymphoproliferative disorder (PTLD) and described the patients' characteristics including Epstein-Barr virus (EBV) information, time from LDLT to PTLD, chemotherapy, and clinical outcome. We also assessed incidences of solid cancers and described reason of disease discovery, time from LDLT to cancer, and clinical outcome.

Results

There were 8 cases of PTLD (3.9%) and 5 cases of solid cancers (2.4% in total cases and 4.2% in adult cases). Eight cases of PTLD consisted of 5 cases of BA, 2 cases of primary sclerosing cholangitis, and 1 case of hepatitis C liver cirrhosis. EBV-PCR at PTLD development and anti-EBV antibody (IgG) at LDLT was positive and negative in the 5 cases of PTLD occurred in BA and was negative and positive in the other 3 cases, respectively. PTLD development was within 1 year from LDLT in 4 of the 5 BA cases and was more than 5 years after LDLT in the other 3 cases. Trough levels of calcineurin inhibitor were reduced in all 8 cases. Rituximab or chemotherapy such as R-CHOP was administered in 7 cases. Complete remission was achieved in 6 cases. As for solid cancer, there were 2 cases of thyroid cancer, 1 case of laryngeal cancer, 1 case of descending colon cancer, and 1 case of rectum cancer. Cancer was discovered due to the patient's complaints in 4 cases and fecal occult blood test in 1 case. Cancer was discovered more than 4 years after LDLT in 4 cases. Four cases were already treated and alive with no recurrence and 1 of the thyroid cancer cases is still under treatment.

Conclusion

PTLD has characteristics of past EBV infection history and time of the onset depending on the background liver disease. The incidence of solid cancer is currently low compared to that of deceased donor liver transplantation reported from western countries, but may increase as the patient follow-up period increases and if medical examinations are scheduled at fixed intervals.