NONLYMPHOID CANCER AFTER LIVER-TRANSPLANTATION

Background/Aims: The increasing length of survival of organ transplant recipients necessitates careful attention to the potential neoplastic complications of life-long immunosuppression, which is required for s uch patients. Previous studies by Penn of patients taking triple drug therapy (Cyclosporin, Azathioprine and Prednisone) for immunosuppressi on, or even of those taking Imuran and Cyclophosphamide, have shown a high percentage of tumor development (3117 per 2915 patients). Methodo logy: Three thousand three hundred and ninety-four adult patients unde rwent orthotopic liver transplantation (OLTx) at the University of Pit tsburgh Medical Center, Transplant Institute prior to December, 1992. Of these, 1657 were examined (48.8%). All patients with hepatic or bil iary cancer as the indication for OLTx were excluded; all other indica tions were considered. All forms of tumor development after OLTx were considered, except for lymphoproliferative disease and hepato-biliary tumors. The immunosuppressive regimens were reviewed and patients trea ted with FK 506 and Cyclosporin A (CSA), as well as those switched fro m CSA to FK 506, were divided into different groups. Results: A total of 50 patients with tumors were identified (37 males, 13 females), ran ging between 34 and 69 years of age. Of these patients, 48 are still a live, In these patients, 64 tumors, classified according to the TRIN c lassification, were discovered: 50 in males and 14 in females. True me tastases were found following discovery of the tumor. The tumors ident ified were as follows: basalioma 25%, squamous 20.3%, Bowen 6.2%, wart s 3.1%, melanoma 6.2%, Kaposi's sarcoma 3.1%, colonic adenocarcinoma 3 .1%, colonic polyps 4.6%, rectal cancer 1.5%, breast cancer 4.6%, cerv ical cancer 3.1%, ovarian cancer 3.1%, laryngeal cancer 3.1%, prostate cancer 1.5%, lung cancer 3.1%, gastric cancer 3.1%, and hemangioblast oma 1.5%. Conclusions: Shin cancer is the most common type of tumor di scovered after liver transplantation (The transplant does not change t he occurrence in lung transplants with a positive smoking history). A lower incidence of tumors was found after, liver transplantation as co mpared to kidney transplantation. A higher incidence of tumors was fou nd with CSA, as opposed to FK 506 immunosuppression therapy. None of t he patients in this series experienced acute graft rejection necessita ting re-transplantation. Chronic graft rejection was treated either wi th FK 506 or with OKT3, without an increase in the incidence of tumor development.