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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2015; 21(29): 8753-8768
Published online Aug 7, 2015. doi: 10.3748/wjg.v21.i29.8753
Neoplastic disease after liver transplantation: Focus on de novo neoplasms
Patrizia Burra, Kryssia I Rodriguez-Castro
Patrizia Burra, Kryssia I Rodriguez-Castro, Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, PD, Italy
Author contributions: Burra P designed and outlined the review, performed the research and a critical revision of the manuscript; and Rodriguez-Castro KI performed the review and wrote the manuscript.
Conflict-of-interest statement: The authors would like to thank Primula Multimedia srl (Pisa) for assistance with manuscript revision before submission. Unconditional support for editorial assistance was funded by Novartis Farma, Italy.
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: Patrizia Burra, MD, PhD, Professor, Head of the Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Via Giustiniani 2, 35128 Padua, PD, Italy. burra@unipd.it
Telephone: +39-49-8212892 Fax: +39-49-8218727
Received: March 13, 2015
Peer-review started: March 14, 2015
First decision: March 26, 2015
Revised: May 31, 2015
Accepted: July 8, 2015
Article in press: July 8, 2015
Published online: August 7, 2015
Processing time: 148 Days and 2.9 Hours
Abstract

De novo neoplasms account for almost 30% of deaths 10 years after liver transplantation and are the most common cause of mortality in patients surviving at least 1 year after transplant. The risk of malignancy is two to four times higher in transplant recipients than in an age- and sex-matched population, and cancer is expected to surpass cardiovascular complications as the primary cause of death in transplanted patients within the next 2 decades. Since exposure to immunosuppression is associated with an increased frequency of developing neoplasm, long-term immunosuppression should be therefore minimized. Promising results in the prevention of hepatocellular carcinoma (HCC) recurrence have been reported with the use of mTOR inhibitors including everolimus and sirolimus and the ongoing open-label prospective randomized controlled SILVER. Study will provide more information on whether sirolimus-containing vs mTOR-inhibitor-free immunosuppression is more efficacious in reducing HCC recurrence.

Keywords: Liver transplantation; De novo neoplasms; Immunosuppression; mTOR inhibitors; Hepatocellular carcinoma

Core tip: With the notable increase in life expectancy after liver transplantation, together with the lengthy exposure to immunosuppression, transplant recipients are at risk of developing neoplastic disease, which accounts for almost 30% of deaths 10 years after liver transplantation. The risk of malignancy is two to four times higher in transplant recipients than in an age- and sex-matched population, and cancer is expected to surpass cardiovascular complications as the primary cause of death in transplanted patients within the next 2 decades, making this an important topic for clinicians to consider.