De novo malignancies after liver transplantation: A major cause of late death

1. Recurrent and de novo malignancies are the second leading causes of late death in liver transplant recipients, following age-related cardiovascular complications. 2. The increased incidence of de novo malignancies in liver transplant reci pients compared with the general population reflects their demographic make up, known preexistent risk factors for cancer, greater rate of chronic vira l infection, and actions of exogenous immunosuppression. 3. The greatest incidence of de novo malignancies is seen in cancers associ ated with chronic viral infections, such as Epstein-Barr virus-associated p osttransplant lymphoproliferative disease, and skin cancers, including squa mous cell carcinoma and Kaposi's sarcoma. 4. Although a greater incidence of such malignancies as oropharyngeal malig nancy and colorectal cancer was noted, there did not appear to be an increa sed risk for liver transplant recipients matched for age, sex, and length o f follow-up using modified life-table technique and Surveillance Epidemiolo gy End Result data with a similar at-risk group. However, they may present with more advanced stages of disease. 5. An increased incidence of de novo cancers in chronically immunocompromis ed liver transplant recipients demands careful long-term screening protocol s to help facilitate diagnosis at an earlier stage of disease.