Abstract
【Objective】Living-donor liver transplantation (LDLT) outcomes have improved with advances in immunosuppression and surgical techniques. However, de novo malignancy after LDLT is a problem, and we aimed to examine its characteristics and surveillance.
【Methods】We retrospectively evaluated 164 recipients who survived for more than a year after undergoing LDLT at our department from July 1996 to October 2013. Postoperative surveillance included abdominal ultrasonography, abdominal computed tomography, gastrointestinal endoscopy, and fecal occult blood analysis.
【Results】Fifteen recipients (9.1%) had de novo malignancies. Lung cancer was the most common malignancy (n=3), followed by breast cancer (n=2). Skin, endometrial, bladder, kidney, tongue, gastric, colon, and pancreatic cancers; leukemia; and malignant lymphoma were also observed (n=1 each). The median duration and 10-year cumulative incidence of de novo malignancy after LDLT were 5.9 years （range, 0.3-10.6 years） and 17.7%, respectively. The incidence of cancer was higher in the LDLT recipients than in the general population (standard incidence ratio, 3.05). Routine surveillance identified de novo malignancy in only 5 patients (33.3%). The remaining patients (n=10) showed symptoms before diagnosis. Twelve cases (92.3%) of solid tumors, except advanced pancreatic cancer, were resected.
【Conclusions】The overall risk of malignancy was higher among LDLT recipients than among the general population. Early detection and treatment of de novo malignancy improved the long-term outcomes of LDLT. Therefore appropriate surveillance methods for de novo malignancy are required.
