P-136 - De novo malignancy after living donor liver transplantation

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Cancer Aetiology, Epidemiology, Prevention
Surgery and/or Radiotherapy of Cancer
Presenter M. Shinoda
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors M. Shinoda1, O. Itano1, H. Obara1, M. Kitagoo1, T. Hibi1, Y. Abe1, H. Yagi1, K. Matsubara1, Y. Yamada2, A. Fujino1, K. Hoshino1, T. Kuroda1, Y. Kitagawa1
  • 1Keio University School of Medicine, Tokyo/JP
  • 2Surgery, Tokyo/JP

Abstract

Introduction

It is reported that Organ transplant recipients have an increased incidence of malignancy. Although more than 25 years has passed since the first case of living-donor liver transplantation (LDLT), the incidence of de novo malignancy after LDLT has not been well reported so far.

Methods

Since 1995, we have performed 229 cases of LDLT (135 adults and 94 children). We assessed incidences of post-transplant lymphoproliferative disorder (PTLD) and described the patients' characteristics including Epstein-Barr virus (EBV) information, time to PTLD diagnosis from LDLT, chemotherapy, and clinical outcome. We also assessed incidences of solid cancers and described reason of disease discovery, time to cancer discovery from LDLT, and clinical outcome. Our recommendation for postoperative medical check-up was as follow: outpatient service visit and blood test every 2 months, CT scan or US every 1 year, and Upper GI endoscopy every 2 year.

Results

I) PTLD: There were 9 cases of PTLD (3.9% in 229 cases). The 9 cases consisted of 5 cases of biliary atresia (BA), 2 cases of primary sclerosing cholangitis, 1 case of hepatitis C liver cirrhosis, and 1 case of acute liver failure. EBV-PCR at PTLD development and anti-EBV antibody (IgG) at LDLT was positive and negative in the 5 BA cases and was negative and positive in the other 4 non-BA cases, respectively. PTLD development was within 1 year from LDLT in 4 of the 5 BA cases and was more than 10 years after LDLT in the other 4 non-BA cases. After diagnosis of PTLD, trough levels of calcineurin inhibitor were reduced in all cases. Rituximab or chemotherapy such as R-CHOP was administered in 8 cases. Complete remission was achieved in 6 cases. II) Solid cancer: Seven solid cancers occurred in 6 cases (2 cancers in 1 case. 3.1% in total cases and 5.2% in adult cases). There were 2 cases of thyroid cancer, 2 cases of lung cancers, 1 case of laryngeal cancer, 1 case of descending colon cancer, and 1 case of rectum cancer. Four cancers were discovered due to the patient's complaints and 3 cancers were discovered by routine medical check-up. Time to cancer discovery from LDLT was more than 5 years after LDLT in 4 cancers and within 5 years in 3 cancers. Five cases (6 cancers) were already treated and alive with no recurrence and 1 case died of the thyroid cancer.

Conclusion

PTLD has characteristics of past EBV infection history depending on the background liver disease. In non-BA cases, the relation between PTLD and EBV infection is unclear. The incidence of solid cancer is currently low compared to that of deceased donor liver transplantation reported from western countries. It is disappointed that only 3 cancers were discovered by routine medical check-up. There is a pressing need to establish an effective protocol for malignancy discovery.