De novo malignancy after liver transplantation

Abstract

De novo malignancies after liver transplantation are the leading cause of patient and graft loss over the long term. In comparison with a normal population, increased standardized incidence ratios have been universally reported as for various neoplasms among liver transplant recipients. Factors associated with de novo malignancy include smoking, alcohol use, alcoholic and fatty liver disease, and some disease specific risks such as inflammatory bowel disease in primary sclerosing cholangitis; however, immunosuppression is the strongest factor predisposing liver transplant recipients to developing de novo malignancies. At present, no immunosuppressive modulation can be recommended to avoid them; however, mTOR inhibitors seem favorable for those developing malignancies. Immune check-point inhibitors are considered as contraindicated for liver transplant recipients in fear of graft loss; however, recent reports have confirmed their efficacy in some cases.