Successful outcome of orthotopic liver transplantation in patients with preexisting malignant states

Preexisting malignancy is considered a relative contraindication to orthoto pic liver transplantation (OLT) because of the risk of tumor recurrence. Th e purpose of this study is to assess the outcome of OLT in patients with a preexistent malignant state. Of 1,097 OLTs performed between 1989 and 1999 at King's College Hospital (London, UK), 18 patients had a pretransplantati on malignant state, including 6 cases of myeloproliferative disorder (MPD) presenting as Budd-Chiari syndrome. Those patients with solid-organ maligna ncies had their tumor detected at an early stage and underwent curative tre atment before or during OLT. Patients were followed up for a median of 71 m onths (range, 1 to 119 months) post-OLT, and the rates of rejection and mal ignancy were compared with those of transplant recipients without preexisti ng malignancy during the same period. One patient had a recurrence of his p rimary malignancy (non-Hodgkin's lymphoma) after 27 months, whereas another patient developed a de novo posttransplant lymphoproliferative disorder af ter 57 months. One patient with MPD developed acute leukemia 72 months afte r OLT. In comparison, of 1,079 OLTs performed in patients without preexisti ng malignancy during the same period, there were 34 cases of de novo malign ancies. The rate of rejection in patients with and without preexisting mali gnancy was similar. Successful medium-term outcome after OLT can be achieve d in carefully selected patients with preexisting malignancy providing the malignancy is amenable to curative treatment before or at OLT. Primary MPDs responsible for Budd-Chiari syndrome should not be considered a contraindi cation to OLT.