Gender, Race and Disease Etiology Predict De Novo Malignancy Risk following Liver Transplantation: Insights for Future Individualized Cancer Screening Guidance.

BACKGROUND: Malignancy after liver transplant (LT) is a leading cause of mortality, but data is limited. The aim of this study was to identify patients at higher risk for de novo malignancies after LT in a large multicenter database.

METHODS: The Scientific Registry of Transplant Recipients database comprising all 108,412 liver transplant recipients across the U.S. between 1987 and March 2015 was analyzed with a median follow-up of 6.95 years. Potential risk factors for malignancies after LT were assessed using Cox regression analysis for the outcome of time to first malignancy.

RESULTS: Mean age 51.9 ± 10.8 years, 64.6% male, 74.5% Caucasian, and 15.8% with previous malignancy. Malignancies during follow-up were 4,483 (41.3%) skin, 1,519 (14.0%) hematologic, and 4,842 (44.7%) solid organ. The 10-year probability of de novo malignancy was 11.5% (11.3-11.8%). On multivariable analysis, age by decade (HR 1.52; p<0.001), male gender (HR 1.28; p<0.001), Caucasian race (compared to other races, HR 1.45-2.04; p<0.001), multiorgan transplant (HR 1.35; p<0.001), previous malignancy (HR 1.34; p<0.001) and alcoholic liver disease, autoimmune, Nonalcoholic steatohepatitis (HR 1.35; p<0.001), and Primary Sclerosing Cholangitis pre-LT (compared to HCV, p<0.001) were associated with higher risk of post-LT malignancy, but type of immunosuppression was not (p=NS).

CONCLUSIONS: This large dataset demonstrates the effects of ethnicity/race and etiologies of liver disease, particularly NASH as additional risk factors for cancer after LT. Patients with these high-risk characteristics should be more regularly and diligently screened.