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Pretransplant Hepatic Malignancy Increases Risk of De Novo Malignancy after Liver Transplantation

Journal of Korean Medical Science 2020년 35권 11호 p.69 ~ 69
박길춘 ( Park Gil-Chun ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery

황신 ( Hwang Shin ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
안철수 ( Ahn Chul-Soo ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
김기헌 ( Kim Ki-Hun ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
문덕복 ( Moon Deok-Bog ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
하태용 ( Ha Tae-Yong ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
송기원 ( Song Gi-Won ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
정동환 ( Jung Dong-Hwan ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
윤영인 ( Yoon Young-In ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
 ( Cho Hui-Dong ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
권재현 ( Kwon Jae-Hyun ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
 ( Chung Yong-Kyu ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
강상현 ( Kang Sang-Hyun ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
최진욱 ( Choi Jin-Uk ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
 ( Jung I-Ji ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
이승규 ( Lee Sung-Gyu ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery

Abstract


Background: Hepatocellular carcinoma (HCC) recurrence and development of de novo malignancy (DNM) after liver transplantation (LT) are the major causes of late recipient death.

Methods: We analyzed the incidence of extrahepatic DNM following living donor LT according to the status of pretransplant hepatic malignancy. We selected 2,076 adult patients who underwent primary LDLT during 7 years from January 2010 to December 2016.

Results: The pretransplant hepatic malignancy group (n = 1,012) showed 45 cases (4.4%) of the following extrahepatic DNMs: posttransplant lymphoproliferative disease (PTLD) in 10; lung cancer in 10; stomach cancer in 6; colorectal cancer in 5; urinary bladder cancer in 3; and other cancers in 11. The pretransplant no hepatic malignancy group (n = 1,064) showed 25 cases (2.3%) of the following extrahepatic DNMs: colorectal cancer in 3; stomach cancer in 3; leukemia in 3; lung cancer in 3; PTLD in 2; prostate cancer in 2; and other cancers in 9. Incidences of extrahepatic DNM in the pretransplant hepatic malignancy and no hepatic malignancy groups were as follows: 1.1% and 0.5% at 1 year, 3.2% and 2.0% at 3 years, 4.6% and 2.5% at 5 years, and 5.4% and 2.8% at 8 years, respectively (P = 0.006). Their overall patient survival rates were as follows: 97.3% and 97.2% at 1 year, 91.6% and 95.9% at 3 years, 89.8% and 95.4% at 5 years, and 89.2% and 95.4% at 8 years, respectively (P < 0.001). Pretransplant hepatic malignancy was the only significant risk factor for posttransplant extrahepatic DNM.

Conclusion: Our results suggest that patients who had pretransplant hepatic malignancy be followed up more strictly because they have a potential risk of primary hepatic malignancy recurrence as well as a higher risk of extrahepatic DNM than patients without pretransplant hepatic malignancy.

키워드

Hepatocellular Carcinoma; De Novo Malignancy; Recurrence; Living Donor Liver Transplantation; Surveillance
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