21. De Novo Malignancies in 1639 Consecutive Living Donor Liver Transplant Recipients: An Experience from India

Background and Aims: Liver recipients like all organ transplant recipients, have a risk of developing denovo malignancies due to prolonged immunosuppression. However, there is limited data on this after living donor liver transplantation (LDLT), wherein immunosuppression levels are less than in deceased donor transplantation. Methods: All 1639 adults who underwent LDLT by our team from January 2006 to December 2014 were analyzed retrospectively for the development of de novo malignancy in the post transplantation period. Results: Of 1639 patients who underwent LDLT, 20 (1.22%) developed de novo malignancy after transplantation, among which 19 were males and 1 female. Of 20 de novo malignancies, 6 had oropharyngeal malignancy (carcinoma of oral and buccal mucosa), 4 lung cancer, 2 squamous cell carcinoma of skin, 2 lymphoma and 1 each had hepatoblastoma, bone tumor, carcinoma stomach; carcinoma ovary, pancreatic cancer and prostate cancer. The mean age at transplantation of patients who subsequently developed de novo malignancy was 50±8.5 years (range, 34–65 years). Mean time of presentation of the malignancy after transplantation was 44±24 months (range 6–85 months). Over a mean follow-up of 36±25 months after the diagnosis of de novo malignancy, 5 patients (16.6%) died. There was no difference in the immunosuppression protocol between the patients who developed de novo malignancies compared to those who didn't. Conclusions: De novo malignancies following LDLT, although uncommon, are associated with significant mortality. Careful screening protocol should be followed post transplantation for early detection and timely treatment of de novo malignancies. The authors have none to declare.