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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 8, 2015; 7(7): 942-953
Published online May 8, 2015. doi: 10.4254/wjh.v7.i7.942
Incidence, risk factors and outcome of de novo tumors in liver transplant recipients focusing on alcoholic cirrhosis
Carlos Jiménez-Romero, Iago Justo-Alonso, Félix Cambra-Molero, Jorge Calvo-Pulido, Álvaro García-Sesma, Manuel Abradelo-Usera, Oscar Caso-Maestro, Alejandro Manrique-Municio
Carlos Jiménez-Romero, Iago Justo-Alonso, Félix Cambra-Molero, Jorge Calvo-Pulido, Álvaro García-Sesma, Manuel Abradelo-Usera, Oscar Caso-Maestro, Alejandro Manrique-Municio, Service of General and Digestive Surgery, Abdominal Organ Transplantation, “Doce de Octubre”, University Hospital, Universidad Complutense de Madrid, 28041 Madrid, Spain
Author contributions: All authors equally contributed to this paper.
Conflict-of-interest: None to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Carlos Jiménez-Romero, MD, PhD, FACS, Service of General and Digestive Surgery, Abdominal Organ Transplantation, “Doce de Octubre”, University Hospital, Universidad Complutense de Madrid, Ctra de Andalucía km 5,4., 28041 Madrid, Spain. luiscarlos.jimenez@salud.madrid.org
Telephone: +34-91-3908077 Fax: +34-91-3908077
Received: July 21, 2014
Peer-review started: July 28, 2014
First decision: August 14, 2014
Revised: September 15, 2014
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: May 8, 2015
Abstract

Orthotopic liver transplantation (OLT) is an established life-saving procedure for alcoholic cirrhotic (AC) patients, but the incidence of de novo tumors ranges between 2.6% and 15.7% and is significantly increased in comparison with patients who undergo OLT for other etiologies. Tobacco, a known carcinogen, has been reported to be between 52% and 83.3% in AC patients before OLT. Other risk factors that contribute to the development of malignancies are dose-dependent immunosuppression, advanced age, viral infections, sun exposure, and premalignant lesions (inflammatory bowel disease, Barrett’s esophagus). A significantly more frequent incidence of upper aerodigestive (UAD) tract, lung, skin, and kidney-bladder tumors has been found in OLT recipients for AC in comparison with other etiologies. Liver transplant recipients who develop de novo non-skin tumors have a decreased long-term survival rate compared with controls. This significantly lower survival rate is more evident in AC recipients who develop UAD tract or lung tumors after OLT mainly because the diagnosis is usually performed at an advanced stage. All transplant candidates, especially AC patients, should be encouraged to cease smoking and alcohol consumption in the pre- and post-OLT periods, use skin protection, avoid sun exposure and over-immunosuppression, and have a yearly otopharyngolaryngeal exploration and chest computed tomography scan in order to prevent or reduce the incidence of de novo malignancies. Although still under investigation, substitution of calcineurin inhibitors for sirolimus or everolimus may reduce the incidence of de novo tumors after OLT.

Keywords: De novo malignancies, De novo tumors tobacco consumption, Alcoholic cirrhosis, De novo cancer, Liver transplant

Core tip: Incidence of de novo tumors is significantly increased in patients who undergo liver transplantation for alcoholic cirrhosis. The association of alcohol and tobacco consumption and immunosuppression contribute to the development of de novo malignancies, mainly located in upper aerodigestive tract, lung and skin.