Risk of virus and non‐virus related malignancies following immunosuppression in a cohort of liver transplant recipients. Italy, 1985–2014

• Published in: International journal of cancer 2018-10, Vol.143 (7), p.1588-1594
• Main Authors: Taborelli, Martina, Piselli, Pierluca, Ettorre, Giuseppe Maria, Lauro, Augusto, Galatioto, Laura, Baccarani, Umberto, Rendina, Maria, Shalaby, Sarah, Petrara, Raffaella, Nudo, Francesco, Toti, Luca, Sforza, Daniele, Fantola, Giovanni, Cimaglia, Claudia, Agresta, Alessandro, Vennarecci, Giovanni, Pinna, Antonio Daniele, Gruttadauria, Salvatore, Risaliti, Andrea, Di Leo, Alfredo, Burra, Patrizia, Rossi, Massimo, Tisone, Giuseppe, Zamboni, Fausto, Serraino, Diego
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenal glands; Adult; Cancer; cancer risk; Cervix; Cohort analysis; cohort study; Esophagus; Female; Follow-Up Studies; Head and neck; Health risk assessment; Health risks; Humans; Immune Tolerance; Immunosuppression; Immunosuppression - adverse effects; Incidence; Italy; Italy - epidemiology; Kaposi's sarcoma; Liver; Liver transplantation; Liver Transplantation - adverse effects; Liver transplants; Lung cancer; Lymphoma; Male; Medical research; Melanoma; Middle Aged; Neoplasms - epidemiology; Neoplasms - etiology; Prognosis; Prospective Studies; Prostate cancer; Risk Factors; Sarcoma; Skin; Statistical analysis; Time Factors; Transplantation; Transplants & implants; viral infection; Virus Diseases - epidemiology; Virus Diseases - etiology; Viruses; Young Adult
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.31552

This cohort study assessed, in Italy, the overall pattern of risk of de novo malignancies following liver transplantation (LT). The study group included 2,832 individuals who underwent LT between 1985 and 2014 in nine centers all over Italy. Person–years (PYs) at cancer risk were computed from 30 days after LT to the date of cancer diagnosis, to the date of death or to the end of follow‐up. Excess cancer risk, as compared to the general population, was estimated using standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). During 18,642 PYs, 246 LT recipients developed 266 de novo malignancies, corresponding to a 1.8‐fold higher cancer risk (95% CI: 1.6–2.0). SIRs were particularly elevated for virus‐related malignancies, including Kaposi's sarcoma (SIR = 53.6, 95% CI: 30.0–88.5), non‐Hodgkin lymphomas (SIR = 7.1, 95% CI: 4.8–10.1) and cervix uteri (SIR = 5.4, 95% CI: 1.1–15.8). Among virus‐unrelated malignancies, elevated risks emerged for head and neck (SIR = 4.4, 95% CI: 3.1–6.2), esophagus (SIR = 6.7, 95% CI: 2.9–13.3) and adrenal gland (SIR = 22.9, 95% CI: 2.8–82.7). Borderline statistically significant elevated risks were found for lung cancer (SIR = 1.4, 95% CI: 1.0–2.1) and skin melanoma (SIR = 2.6, 95% CI: 1.0–5.3). A reduced risk emerged for prostate cancer (SIR = 0.1, 95% CI: 0.0–0.5). These findings underline the need of preventive interventions and early detection of malignancies, specifically tailored to LT recipients. What's new? Liver transplantation often requires long‐term immunosuppressive therapy, which increases the risk of certain infections and malignancies. The extent to which chronic immunosuppressant use impacts cancer risk following liver transplantation, however, remains unclear. In this multicenter cohort study in Italy, liver transplant recipients had an overall 1.8‐fold higher cancer risk compared with the general population. Risk was elevated for virus‐related malignancies, as well as for several cancers not associated with viral infections, including cancers of the head and neck, esophagus, and adrenal gland. The findings support further investigation into the prevention and early detection of cancer in liver transplant recipients.