INCIDENCE AND PREDICTORS OF POST-TRANSPLANT MALIGNANCY IN LIVER TRANSPLANT RECIPIENTS: A SINGLE-CENTRE COHORT STUDY

Introduction and Objectives

Cancer is a major long-term complication after liver transplantation (LT). We aimed to characterize its incidence and risk factors in LT recipients at a Canadian center.

Materials and Methods

Retrospective cohort of patients who underwent LT from 2007–2018, with at least 60 months of follow-up. Demographic, clinical, and oncologic data were analyzed using Cox regression.

Results

We included 575 LT recipients (30% women, median age 53.6 years). Main etiologies were ALD (22.9%), HCV (20.8%), MASLD (13.3%), and PSC (11.1%). HCC was present at LT in 25.7%. During follow-up, 55 patients (9.7%) developed cancer, most commonly non-melanoma skin cancer (3.5% of all recipients), followed by head and neck tumors (1.0%), PTLD (0.9%), gastrointestinal cancers (0.9%), and neuroendocrine tumors (0.7%). Mean time to cancer diagnosis was 27.3±19.1 months. Additionally, 20 patients (3.4%) developed post-LT HCC, with 90% being recurrences. Cancer types differed by underlying etiology (p=0.004): non-melanoma skin cancers predominated in SLD and viral hepatitis, while GI cancers were most common in autoimmune liver disease. Among those with prior HCC, 16.8% developed a non-HCC cancer, mostly skin cancer. In multivariate analysis, pre-LT HCC was independently associated with post-LT non-HCC cancer (HR 2.66; 95% CI 1.39–5.07; p=0.003), while age, gender, alcohol or tobacco use, and liver disease etiology were not.

Conclusions

Cancer occurred in nearly 10% of LT recipients, mostly within three years. A history of HCC at LT tripled the risk of subsequent non-HCC cancer, highlighting the importance of targeted cancer surveillance in this high-risk population.

Conflict of interest: None

Distribution of cancer types by pre-transplant liver disease etiology