Cancer in liver transplant recipients: Management and outcomes

Aim: To investigate the management and cancer outcomes of liver transplant recipients. Method: An audit of all liver transplant recipients from a single liver transplant center from January 1991 to March 2010. Data were obtained from case notes, cancer registry and clinical databases. Results: 198 transplant recipients were identified and 49 (25%) were confirmed as having post-transplantation malignancies. Of these 32 (16%) patients developed skin malignancies and 17 (9%) developed post-transplant non-skin malignancies. All skin malignancies had local involvement only and none of the patients with skin malignancies developed nodal or distant metastases. All were managed with local treatment. Of those with non-cutaneous malignancies, four were managed with local therapy alone, two with immunosuppression reduction, seven with chemotherapy, including two with chemoradiotherapy, one with a targeted agent and three with supportive care only. None of the patients who were treated with chemotherapy for non-skin malignancies were able to complete the full prescribed dose of chemotherapy as a result of chemotherapy-related toxicities. Of those treated with chemotherapy one died of hepatic failure and one of chemotherapy-related infection. Conclusion: Liver transplant recipients are at high risk of cancer. Outcomes for liver transplant recipients with post-transplant malignancy are excellent if detected when they are amenable to local therapy alone. Outcomes are poor, with high rates of treatment-associated toxicity, in patients who require systemic therapy. Further research is required to enable the development of guidelines for the safe administration of systemic treatment in this group.