Malignancy after liver transplantation in patients with premalignant conditions

Liver transplant recipients are at increased risk of developing nonhepatic malignant tumors. The aim of the current study was to evaluate the role of premalignant states, not associated with the liver disease prior to transplantation, in the development of posttransplantation malignancy.

One hundred seventy-five patients who had undergone liver transplantation were retrospectively evaluated for the development of malignant conditions. Each of the patients who developed malignancy following transplantation was evaluated for the presence of premalignant conditions before transplantation.

Post-liver transplantation malignancy was identified in 13 patients (7.4%). Five patients developed non-Hodgkin lymphoma: four had posttransplantation lymphoproliferative diseases, and one had B cell lymphoma of the stomach. Eight patients developed solid tumors. In five of these patients, evidence of a premalignant state was identified: ulcerative colitis was diagnosed in 1 patient with carcinoma of the colon; colonic polyp, 1 patient with carcinoma of the colon; Barrett esophagus, 1 patient with esophageal carcinoma; Caroli disease, 1 patient with anaplastic cholangiocarcinoma; and cervical atypia, 1 patient with carcinoma of the cervix.

Premalignant conditions existing before transplantation, which are not associated with the primary liver disease, are major risk factors for posttransplantation malignancy. Screening for premalignant conditions should be included in pretransplantation evaluation. Liver transplant patients with evidence of a premalignant state should be followed after transplantation for detection of malignancy.