Risk factors of de novo malignancies after liver transplantation: a French national study on 11004 adult patients - 16/06/21
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Highlights |
• | After liver transplantation (LT), de novo malignancies are one of the leading causes of late mortality. |
• | Risk factors of de novo malignancies in a large cohort of LT recipients (n=11004) are described using Fine and Gray competing risks regression analysis. |
• | The overall incidence of de novo malignancies was 13.45%. |
• | Were significant risk factors for de novo malignancy: recipient age, male gender, non-living donor, a first LT and the type of initial liver disease. |
• | Initial immunosuppressive regimen had no significant impact. |
Abstract |
Background |
After liver transplantation (LT),de novo malignancies are one of the leading causes of late mortality. The aim of the present retrospective study was to identify the risk factors of de novo malignancies in a large cohort of LT recipients in France, using Fine and Gray competing risks regression analysis.
Methods |
The study population consisted in 11004 adults transplanted between 2000 and 2013, who had no history of pre-transplant malignancy, except primary liver tumor. A Cox model adapted to the identification of prognostic factors (competitive risks) was used.
Results |
From the entire cohort, one (or more)de novo malignancy was reported in 1480 L T recipients (13.45%). The probability to develop a de novo malignancy after LT was 2.07% at 1 year, 13.30% at 5 years, and 28.01% at 10 years. Of the known reported malignancies, the most common malignancies were hematological malignancy (22.36%), non-melanoma skin cancer (19.53%) and lung cancer (12.36%). According to Fine and Gray competing risks regression multivariate analysis, were significant risk factors for post-LT de novo malignancy: recipient age (Subdistribution Hazard Ratio (SHR) = 1.03 95%CI 1.03−1.04), male gender (SHR = 1.45 95%CI 1.27−1.67), non-living donor (SHR = 1.67 95%CI 1.14−2.38), a first LT (SHR = 1.35 95%CI 1.09−1.69) and the type of initial liver disease (alcohol-related liver disease (SHR = 1.63 95%CI 1.22−2.17), primary sclerosing cholangitis (SHR = 1.98 95%CI 1.34−2.91), and primary liver tumor (SHR = 1.88 95%CI 1.41−2.54)). Initial immunosuppressive regimen had no significant impact.
Conclusion |
The present study confirms that LT recipient characteristics are associated with the risk ofde novo malignancy and this underlines the need for personalized screening in order to improve survival.
Le texte complet de cet article est disponible en PDF.Abbreviations : ALD, CI, HCC, LT, PSC, SIR, SHR
Keywords : Liver transplantationde novomalignancies, Competing risk
Plan
Vol 45 - N° 4
Article 101514- juillet 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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