Neoplastic disease after liver transplantation: Focus on de novo neoplasms

Table 1 Estimated standardized incidence ratios for de novo malignancies after liver transplantation (data according to[7,9,15,46-48,61,72,174-182])

Cancer site/type	Estimated incidence (%)	SIR
All cancers	5-6	1.94-3
Kaposi’s sarcoma	0.14-2.8	> 100
Skin (non melanoma)	0.9-3.2	> 30
PTLD	0.9-2.6	6-20
Gastrointestinal and oropharyngeal sites
Lip/oropharyngeal/head and neck cancers	0.1-2.0	5-14
Esophagus1	0.5-1.19	12-18.7
Colorectal overall	0.0-0.65	1.41
Colorectal in IBD/PSC	0.7-7.9	3-5
Stomach	0.25	3
Vulva	0.25	8-23.8
Lung	0.6-1.2	2-8
Renal	0.35	2-2.65
Thyroid	0.20	4.60
Prostate	0.25-0.6	1 (risk not increased)
Breast	0.40	1 (risk not increased)
Colorectal in non-IBD/PSC	0.30	1 (risk not increased)

¹Although there are no population-based SIR estimates showing an increased risk of esophageal cancer after LT, an Italian study reported an SIR of 23.4 on the basis of cases ascertained by medical record reviews[178]. This association may be related to prior alcohol exposure; 2 of 3 patients diagnosed with esophageal cancer in a US cohort underwent LT for ALD[1]. IBD: Inflammatory bowel disease; PSC: Primary sclerosing cholangitis; PTLD: Posttransplant lymphoproliferative disease; SIR: Standardized incidence ratio.

Table 2 Risk factors for the development of de novo malignancies according to tumor location/type (data according to[5,14-17,20-22,25,26,46,48,50,53,54,61,62,64,75,130,181,183,184])

Tumor location/type	Risk factor
Skin	Age > 40 yr
	Male gender
	Skin type
	Sun exposure
	Smoking
	Alcoholic cirrhosis
	Primary sclerosing cholangitis as indication for LT
	Cyclosporine-based immunosuppression
KS	Increased intensity of immunosuppression
	Infection with HHV-8
PTLD	Age > 50 yr
	Infection with EBV (especially seronegative recipients of organs from EBV seropositive donors)
	Increased intensity of immunosuppression
	OKT3 or anti-thymocyte globulin
	Cyclosporine-based immunosuppression
	Hepatitis C virus
Lung cancer	Cigarette smoking
	LT for alcohol-related liver disease
Head and neck cancers	Cigarette smoking
	LT for alcohol-related liver disease
Esophageal and gastric cancers	LT for alcohol-related liver disease
	Barrett’s Esophagus
Colorectal cancer	Primary sclerosing cholangitis
	Inflammatory bowel disease
De novo HCC	Recurrence of liver disease in the allograft
Gynecologic cancers	Insufficient evidence
Genitourinary cancers	Insufficient evidence

EBV: Epstein-Barr virus; HCC: Hepatocellular carcinoma; HHV-8: Human herpesvirus 8; KS: Kaposi’s sarcoma; LT: Liver transplantation; PTLD: Post-transplant lymphoproliferative disorder.

Table 3 Intensive screening protocols for tumor surveillance in liver transplant recipients (data according to[128-130])

Traditional screening	Intensive screening
Annual chest X-ray	Annual chest and abdominal CT
Annual abdominal ultrasound	Annual abdominal ultrasound
Chest and abdominal CT	Annual urologic screening with PSA determination
Mammography and urologic screening (with timing according to standard of care)	Annual Pap smear and mammography (every 1-2 yr)
	Annual skin examination
	Colonoscopy 1 year after LT in patients with adenoma on pre-LT colonoscopy, and repeated every 2-4 yr if more adenomas are found. Colonoscopy repetition every 10 yr in patients > 50-yr-old
	Ears, nose and throat clinic visit in patients with > 20 pack year smoking

CT: Computed tomography; PSA: Prostatic specific antigen; LT: Liver transplant.