Chronological alterations in de novo malignancies after living-donor liver transplantation: A cohort study of 1781 recipients using annual comparisons of standardized incidence ratios

IF 3.2 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Journal of Hepato‐Biliary‐Pancreatic Sciences Pub Date : 2024-06-06 DOI:10.1002/jhbp.12002

Tetsuya Tajima, Koichiro Hata, Kosuke Tanaka, Naomi Iyama, Jiro Kusakabe, Shoichi Kageyama, Eri Ogawa, Tatsuya Okamoto, Hironori Haga, Shinji Uemoto, Etsuro Hatano

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Abstract

Background

De novo malignancies (DNMs) are a major adverse event after solid organ transplantation; however, their characteristics and recent trends after living-donor liver transplantation (LDLT) remain unclear.

Methods

We retrospectively reviewed 1781 primary LDLT recipients (1990–2020) and annually calculated standardized incidence ratios (SIRs) of DNMs compared to the age-adjusted Japanese general population.

Results

After 21 845 person-years follow-up, 153 DNM lesions (8.6%) were identified in 131 patients (7.4%). The incidence was 0.007 person-years. DNMs included 81 post-transplant lymphoproliferative disorders (PTLDs), 14 colorectal, 12 lung, and 12 gastric cancers, and so on. Comorbid DNMs significantly worsened recipient survival than those without (p < .001). The 5- and 10-year recipient survival after DNM diagnosis were 65% and 58%, respectively. Notably, SIR_1993–1995: 8.12 (95% CI: 3.71–15.4, p < .001) and SIR_1996–1998: 3.11 (1.34–6.12, p = .01) were significantly high, but had decreased time-dependently to SIR_2005–2007: 1.31 (0.68–2.29, p = .42) and SIR_2008–2010: 1.34 (0.75–2.20, p = .33), indicating no longer significant difference in DNMs development. Currently, however, SIR_2014–2016: 2.27 (1.54–3.22, p < .001) and SIR_2017–2019: 2.07 (1.40–2.96, p < .001) have become significantly higher again, reflecting recent aging of recipients (>50 years) and resultant increases in non-PTLD DNMs. Furthermore, characteristically in LDLT, the fewer the donor-recipient HLA-mismatches, the less the post-transplant DNMs development.

Conclusion

DNM development after LDLT was significantly higher than in the general population due to higher PTLD incidence (1993-1998), but once became equivalent (2005-2013), then significantly increased again (2014-2019) due to recent recipient aging and resultant increase in solid cancers.

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活体肝移植后新发恶性肿瘤的时间变化：使用标准化发病率年度比较法对 1781 名受者进行队列研究。

背景：新发恶性肿瘤（DNMs）是实体器官移植后的主要不良事件；然而，活体肝移植（LDLT）后DNMs的特征和最新趋势仍不清楚：方法：我们回顾性研究了1781例LDLT初治受者（1990-2020年），并与年龄调整后的日本普通人群相比，每年计算DNM的标准化发病率（SIR）：经过 21 845 人年的随访，在 131 名患者（7.4%）中发现了 153 个 DNM 病灶（8.6%）。发病率为 0.007 人/年。DNM 包括 81 例移植后淋巴增生性疾病（PTLD）、14 例结直肠癌、12 例肺癌和 12 例胃癌等。与没有并发 DNM 的受者相比，并发 DNM 会明显降低受者的生存率（p 1993-1995: 8.12 (95% CI: 3.71-15.4, p 1996-1998: 3.11 (1.34-6.12, p = .01)）：1.31 (0.68-2.29, p = .42) 和 SIR2008-2010：1.34 (0.75-2.20, p = .33)，表明 DNM 的发展不再有显著差异。但目前，SIR2014-2016：2.27（1.54-3.22，p 2017-2019：2.07（1.40-2.96，p 50 年），非 PLD DNMs 因此增加。此外，在 LDLT 中，供体与受体 HLA 不匹配的情况越少，移植后出现 DNM 的情况就越少：结论：由于PTLD发病率较高（1993-1998年），LDLT术后DNM的发生率明显高于普通人群，但曾一度持平（2005-2013年），随后由于近期受者老龄化和实体瘤的增加，DNM的发生率再次明显增加（2014-2019年）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hepato‐Biliary‐Pancreatic Sciences GASTROENTEROLOGY & HEPATOLOGY-SURGERY

自引率

10.00%

发文量

178

审稿时长

6-12 weeks

期刊介绍： The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.