De novo malignancy after living donor liver transplantation: a large volume experience

Abstract Introduction Liver transplantation recipients like all organ transplant recipients, have a risk of developing de novo malignancies due to prolonged immunosuppression. However, there is limited data on this after living donor liver transplantation (LDLT), wherein immunosuppression levels are less than in deceased donor transplantation. Materials and methods A total of 2100 adults (age >18 years) who underwent liver transplantation between January 2006 and December 2017 were retrospectively analyzed from a prospectively collected database. The data was analyzed up to June 2019. Data is shown as number, percentage, mean ± standard deviation, median [interquartile range (IQR)]. Results Of 2100 patients who underwent LDLT, 21 (1%) patients developed de novo malignancy after transplantation. The de novo malignancy cohort comprised of 20 males and 1 female, aged 50±8.8 years. The distribution of de novo malignancies was as follows: 7 oropharyngeal (carcinoma of buccal and oral mucosa), 4 lung, 2 squamous cell carcinoma of skin, 2 lymphoma, 1 each of brain, colonic, gastric; ovary, pancreatic and prostate. These malignancies were diagnosed at a median follow-up of 42 months (32-73) after liver transplantation. Over a median follow-up of 38 months (10-56) after the diagnosis of de novo malignancy, 6 patients (28.5%) died. Patients with de novo malignancy had a higher follow up after LDLT, 94.3±32.9 versus 62.5±41.8 months, p=0.000. Patients with alcohol as etiology for liver transplantation had higher trend of de novo malignancies (33.3% versus 26.4%), p=0.46. Conclusion The incidence of de novo malignancy was 1% at a median follow up of 42 (32-73) months. De novo malignancies following LDLT, although uncommon, are associated with significant mortality. A careful screening protocol should be followed post transplantation for early detection of de novo malignancies.