Solid, non-skin, post-liver transplant tumors: Key role of lifestyle and immunosuppression management

Table 1 Standardized incidence ratio (95%CI) of non-skin solid cancer after liver transplantation, n (range)

Ref.	LT patients (n)	Country	Median follow-up time (yr)	All non-skin solid tumors	Head and neck	Lung	Colorectal	Anal	Esophageal	Pancreatic	Kidney	Prostate	Urological tract	Kaposi’s sarcoma	Breast	Cervical
Engels et al[7]	37958	United States				1.9 (1.7-2.2)					1.8 (1.4-2.3)
Collett et al[9]	6771	United Kingdom		2.2 (2-2.4)	10 (5.9-16)	1.6 (1.2-2.2)	2.3 (1.7-3)	3.3 (0.4-12)			1.8 (0.8-3.6)			0	0.8 (0.5-1.1)
Ettorre et al[18]	1675	Italy	5.2	0.9 (0.7-1.2)	4.5 (2.7-7.1)	1.1 (0.9-1.9)	1.2 (0.6-2.2)			1.1 (0.3-3.9)			0.8 (0.3-1.6)		0.7 (0.1-1.9)
Aberg et al[6]	540	Finland	6.3		14.8 (0.4-82)	0	1.6 (0.2-5.7)			2.3 (0.1-13)	4.2 (0.5-15)	1.2 (0.2-4.5)			0.3 (0.1-1.4)
Herrero et al[12]	297	Spain	6.5	2.34 (1.7-3.2)	4.1 (1.7-8.5)	2.4 (0.6-4)	2.5 (1.3-3.5)						2.9 (1.7-4.8)
Baccarani et al[8]	417	Italy	6.8	2.6 (1.9-3.6)	7 (3-13.7)	1.6 (0.4-4.1)	1.4 (0.2-5.1)		23.4 (4.6-55)					144 (53-313)	0.6 (0-3.4)	30.7 (6.3-90)
Jiang et al[14]	2034	Canada		2.5 (2.1-3)	2.5 (0.5-7.3)	1.4 (0.7-2.6)	2.6 (1.4-4.4)			3.3 (0.7-9.6)	3.1 (0.8-7.9)	1 (0.3-2.4)			0.6 (0.2-1.4)
Haagsma et al[4]	174	The Netherlands	5.1	4.4 (2.4-7.3)	2.7 (1.2-5.2)		12.5 (2.5-36)				30 (6.1-87)
Hsiao et al[15]	444	Taiwan	4.2		0 (0-5.7)	1.9 (0.2-6.7)	0 (0-2.84)			6.2 (0.1-34)			10.2 (1.1-36)	0	2.3 (0.3-8.4)
Kaneko et al[16]	360	Japan	7.5		3.7 (0.5-26)		3.5 (1.8-7)		16.9 (2.4-18)	6.4 (1.6-25)		2.2 (0.6-8.9)			0.9 (0.1-6.4)
Maggi et al[17]	494	Italy	7.2	2 (1.4-2.9)	3.4 (0.9-8.8)	2.1 (0.8-4.6)	1.6 (0.3-4.6)					1.6 (0.4-4.1)	2.9 (1-6.9)	128 (51-263)	1 (0.2-2.9)	5.7 (0.1-32)
Carenco et al[13]	465	France	7.8	3.7 (2.8-4.9)	15.8 (9.4-27)	5.1 (2.9-9)	2.7 (1.3-5.6)		10.5 (3.9-28)					0

SIR: Standardized incidence ratio.

Table 2 Risk factors for non-skin solid tumors after liver transplantation from multivariate analyses

	Ref.	Risk factor	Associated cancer	SIR, HR, RR, or OR (95%CI)
Viral infection	Baccarani et al[8]	HPV exposure	Cervical	SIR = 30.7 (6.3-90)
	Collett et al[9]		Anal	SIR = 3.3 (0.4-12)
	Baccarani et al[8]	HHV8 exposure	Kaposi’s sarcoma	SIR = 144 (53-313)
	Maggi et al[17]			SIR = 128 (51-263)
Demographic data	Herrero et al[22]	Recipient’s age	All non-skin tumors	HR = 1.90 (1.32-2.73)
	Watt et al[23]		All non-skin solid tumors	HR = 1.33 (1.05-1.66)
	Herrero et al[34]		Smoking-related tumors	HR = 1.09 (1.03-1.15)
Indication for LT	Watt et al[23]	Alcohol cirrhosis	All non-skin solid tumors	HR = 2.14 (1.22-3.73)
		Primary sclerosis cholangitis	All non-skin solid tumors	HR = 2.62 (1.50-4.56)
Lifestyle	Benlloch et al[53]	Alcohol consumption	All non-skin tumors	RR = 3 (1.5-5.8)
	Herrero et al[22]			HR = 2.87 (1.15-7.19)
	Herrero et al[22]	Tobacco consumption	All non-skin tumors	HR = 3.07 (1.32-7.16)
	Watt et al[23]		All non-skin solid tumors	HR = 1.72 (1.06-2.79)
	Carenco et al[13]			OR = 5.5 (2.5-12)
	Herrero et al[34]		Smoking-related tumors	HR = 19.17 (4.17-88.10)
	Carenco et al[13]			OR = 14.7 (1.8-119)
	Carenco et al[13]	Obesity	All non-skin solid tumors	OR = 2.2 (1.1-4.3)
Immunosuppression	Carenco et al[49]	Mean tacrolimus TC during first year post-LT	All non-skin solid tumors	OR = 2.01 (1.57-2.59)

SIR: Standardized incidence ratio; HPV: Human papilloma virus; HHV8: Herpes human virus 8; HR: Hazard ratio; RR: Relative risk; OR: Odds ratio; CI: Confidence interval; TC: Through concentration.