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Gender, Race and Disease Etiology Predict De Novo Malignancy Risk After Liver Transplantation

Insights for Future Individualized Cancer Screening Guidance

Bhat, Mamatha, MD1,2; Mara, Kristin, MS3; Dierkhising, Ross, MS4; Watt, Kymberly D., MD4

doi: 10.1097/TP.0000000000002113
Original Clinical Science—Liver

Background Malignancy after liver transplant (LT) is a leading cause of mortality, but data is limited. The aim of this study was to identify patients at higher risk for de novo malignancies after LT in a large multicenter database.

Methods The Scientific Registry of Transplant Recipients database comprising all 108 412 LT recipients across the United States between 1987 and March 2015 was analyzed with a median follow-up of 6.95 years. Potential risk factors for malignancies after LT were assessed using Cox regression analysis for the outcome of time to first malignancy.

Results Mean age 51.9 ± 10.8 years, 64.6% male, 74.5% white, and 15.8% with previous malignancy. Malignancies during follow-up were 4,483 (41.3%) skin, 1519 (14.0%) hematologic, and 4842 (44.7%) solid organ. The 10-year probability of de novo malignancy was 11.5% (11.3-11.8%). On multivariable analysis, age by decade (hazard ratio [HR], 1.52; P < 0.001), male sex (HR, 1.28; P < 0.001), white race (compared with other races: HR, 1.45-2.04; P < 0.001), multiorgan transplant (HR, 1.35; P < 0.001), previous malignancy (HR, 1.34; P < 0.001), and alcoholic liver disease, autoimmune, nonalcoholic steatohepatitis (HR, 1.35; P < 0.001), and primary sclerosing cholangitis pre-LT (compared with hepatitis C virus, P < 0.001) were associated with higher risk of post-LT malignancy, but type of immunosuppression was not (P = NS).

Conclusions This large data set demonstrates the effects of ethnicity/race and etiologies of liver disease, particularly nonalcoholic steatohepatitis as additional risk factors for cancer after LT. Patients with these high-risk characteristics should be more regularly and diligently screened.

1 Multiorgan Transplant Program, University Health Network, Toronto, Ontario, Canada.

2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

3 Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.

4 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.

Received 10 September 2017. Revision received 11 December 2017.

Accepted 15 December 2017.

This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C.

The authors declare no conflicts of interest.

M.B., K.M., R.D., K.W. were involved in study concept and design. K.M. and R.D. were involved in the acquisition of data. K.M. and R.D. were involved in the analysis of data. All authors were involved in the interpretation of data, drafting of the article, and critical revision of the article for important intellectual content.

Correspondence: Kymberly D Watt, MD, Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, CH-10200, First St., S.W., Rochester, MN 55905. (

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