COMPARATIVE INCIDENCE OF DE-NOVO NONLYMPHOID MALIGNANCIES AFTER LIVER-TRANSPLANTATION UNDER TACROLIMUS USING SURVEILLANCE EPIDEMIOLOGIC ENDRESULT DATA

Background. An increased incidence of de novo non-lymphoid malignancie s has been shown in immunocompromised patients. However, the true risk over time compared to the general population has not been determined. Methods. One thousand consecutive patients were carefully followed fo r an average of 77.8+/-11.1 (range, 56.3-96.3) months after primary li ver transplantation at a single center. All de novo nonlymphoid malign ancies were recorded. Each malignancy was compared with a standard Occ upational Cohort Mortality Analysis Program population matched for age , sex, and length of follow-up using modified life table technique and surveillance epidemiology end result (SEER) data. Results. Fifty-seve n patients accounted for de novo malignancies and contributed 4795.3 t otal person years, a mean+/-SD of 36+/-21 (median, 36; range, 6-74) mo nths after liver transplantation. Twenty-two of these malignancies wer e skin malignancies including two melanomas. Oropharyngeal cancers (n= 7) were found to be 7.6 times higher (P<0.05) and respiratory malignan cies (n=8) were 1.7 times higher (P>0.05) compared to the SEER inciden ce rate. Female reproductive system malignancies including breast canc er (n=3) were 1.9 times lower (P>0.05) and genitourinary malignancies were (n=5) 1.5 times lower (P>0.05) than their matched cohorts. No dif ferences was observed in gastrointestinal malignancies (n=5). There wa s a significant difference in survival of the patients after diagnosis of malignancy depending on the type of cancer. There were two Kaposi' s sarcomas, two metastatic unknown primaries, one thyroid, one brain,; and one ophthalmic malignancies in the series. Mortality for Kaposi's and metastatic disease of unknown primary was 100% within 5 months, wh ile the 1-year mortality for oropharyngeal cancer was 57.1% and that f or lung cancers was 62.5%, Long-term survival for skin cancer was high est: 86.4% at 3 years (P=0.015 by log-rank test). Conclusion. An incre ased incidence of de novo cancers in the chronically immunocompromised patient demands careful long-term screening protocols which will help to facilitate the diagnosis at an early stage of the disease. This is particularly true for oropharyngeal cancers where the risk; is more t han 7 times higher compared to SEER incidence data matched for age, se x, and length of follow-up.