Cumulative Risk Assessment for De Novo and Recurrent Nonliver Cancer After Liver Transplantation Based on Pretransplant Cancer Experience.

[BACKGROUND] As cancer therapeutics improve, more liver transplant (LT) candidates will have a history of prior to transplant malignancy (PTM), an established risk for cancer posttransplant.

[METHODS] This study provides granular analysis (with focus on nonliver PTM) of posttransplant cancer risk relating to PTM in 1105 consecutive adult LT recipients (2009-2019, N = 542 with PTM).

[RESULTS] PTM prevalence increased from 37.8% to 63.2% during this timeframe. Post-LT survival was lower (10 y: 61.2% versus 75.1%; P  < 0.001) with higher cancer-related mortality (17.6% versus 2.2%; P  < 0.001) in patients with any PTM. The higher cumulative incidence of cancer post-LT associated with PTM (59.7% versus 37.6%; P  < 0.001) was not attributable to de novo cancer (38.5% versus 37.7%; P  = 0.21) but to recurrence. Cancer recurrence rate (10 y) was lowest in nonliver/nonskin ("other") PTM (10.6%) with mortality rates from recurrence of only 4% in this cohort. De novo cancers may present at more advanced stage in patients with PTM and lung cancer the most common nonskin de novo malignancy (PTM 21%, no PTM 7%). Family history of cancer was an independent predictor for de novo cancer.

[CONCLUSIONS] PTM associated post-LT cancer outcomes are dominated by skin and liver cancer recurrence and not recurrence of "other" cancers or de novo cancer. This data supports the guidance proposals for cautious liberalization of "other" cancer remission requirements before transplantation. As post-LT cancer is highly prevalent regardless of PTM status, adherence to posttransplant cancer screening and surveillance is critical to identify early cancer after transplant.