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  • We detail malignancies in organ transplant recipients as a whole.

  • Observations that apply exclusively to liver recipients are specifically mentioned.


  • Skin cancers account for the largest nonlymphoid class of de novo malignancies after liver transplantation.1

  • 2-7 fold higher risk.2

  • Incidence:2

    • Reported 2.2% to 26% overall

    • 10%-14.6% at 5 years

    • 20%-32% at 10 years

  • 37% of de novo malignancies after transplantation are nonmelanoma skin cancers (NMSC).2

  • More likely to be diagnosed with American Joint Commission on Cancer (AJCC) stage 2 or greater.2

  • Worse survival.2

  • 2.9 relative risk (RR) relative risk of cancer-related mortality (with respect to general population).2

  • Lower standardized incidence ratio (SIR 2.2) of de novo malignancies among liver transplant recipients when compared to heart (2.5) and to lung (3.6) recipients.2

  • Recurrent and de novo malignancies are the second most frequent cause of late death after liver transplantation, only surpassed by cardiovascular-associated mortality.1

  • When compared to the general population, liver transplantation recipients have a greater incidence of de novo malignancies.1

  • De novo malignancies attributable to chronic viral infections have the greatest incidence.1

  • The development of de novo malignancies after liver transplantation has been estimated to range from 4% to 16%.1

  • The overall frequency of nonlymphoid de novo cancers increases proportionally to the length of follow-up.1

  • Malignancy is one of the leading causes of mortality after transplantation, especially in the long term.3

  • Some of the cancers with higher frequency in transplant recipients include:3

    • Non-Hodgkin lymphoma

    • NMSC (non melanoma skin cancer)

    • Kaposi sarcoma

    • Cervical cancer

  • Although a viral oncogenic association has been observed in the transplant population, it is likely to involve multifactorial components.3

  • The greater incidence of cardiovascular disease, chronic kidney disease, and infections among transplant recipients increases the risk of potential complications, morbidity, and mortality associated with medical and surgical oncologic interventions.3

  • Immunosuppressive agents may have a direct carcinogenic power that associates them with malignancies rather than an indirect effect via immunosuppression.3

  • Skin cancers are aggressive and may have a poor response to established treatments.4


  • Immunosuppression has been implicated in increasing the cancer risk associated with latent oncogenic viral infections.2

  • Rejection episodes were not associated with a greater risk of malignancies after liver transplantation.2

    • Calcineurin inhibitors

      • Inhibit T lymphocytes and increase tumor proliferation in animal models of colon cancer (especially cyclosporine).3

      • Tacrolimus associated with a lower relative risk of skin cancers when compared to cyclosporine.4

        • Cyclosporine is associated with resistance to apoptosis in ultraviolet light (UV)–exposed keratinocytes.4

        • Tacrolimus is not associated with resistance to apoptosis in UV-exposed keratinocytes.4

    • Mammalian target of rapamycin (mTOR) inhibitors:

      • Some nonprospective studies report lower rates of hepatocellular carcinoma (HCC) recurrence and de novo malignancies in liver and kidney recipients treated with mTOR inhibitors.2

      • Increasing evidence to ...

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