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Thorough Pre-Transplant Evaluation and Appropriate Case Selection is the Mainstay for Better Survival in Recipients With Malignancy

Yin, Wen Yao1,2

doi: 10.1097/01.tp.0000520314.71584.87
116.10
Free

1Surgery, Dalin Tzu Chi General Hospital, Chia I, Taiwan; 2Surgery, Hualien Tzu Chi University Hospital, Hualien, Taiwan.

Introduction: Malignancy has become one of the three major causes of death after transplantation in the past decade and is thus increasingly important in all organ transplant programs. Death from cardiovascular disease and infection are decreasing proper screening, prophylaxis, aggressive risk factor management, and interventional therapies. Cancer, on the other hand, is poorly screened both in recipient and donor to prevent post-transplant malignancy.

Method: We review the cases of liver and kidney transplant patients taken care in Dalin Tzu Chi General hospital in the past twelve years. We reviewed the issues on cancer before transplant, any cancer transmission from the donor, cancer after transplantation, outcomes of transplant recipients with cancer, and the role of screening and therapy in reducing the impact of cancer in transplant recipients.

Results: 1. There were 39 liver transplant and 44 kidney transplant patients with a total of 83 cases in this study. Sixteen cases (19.28 %) were associated with different types of malignancy. A total of 16 cases (19.28%) died in this study. 2. Among the kidney transplant patients, a total of 5 cases had malignancy: one renal cell carcinoma (RCC), three Transitional cell carcinoma (TCC) and one colon cancer. Two TCC cases were de novo malignancy. 3. A case of TCC died of recurrence and no definite cancer was seen in the all 7 cases of LDKT. 4. Among the liver transplant patients, 5 cases of living donor liver transplant (LDLT) and 4 cases of deceased donor liver transplant (DDLT) patients were associated with malignancy. 5. No recurrence after follow up of 2 months to 7 years except a patient with an occult cecal cancer underwent laparoscopic radical right hemicolectomy two months after LDLT. He died of distant metastases one year after transplant. 6. Four cases of malignancy in DDLT: two HCC, one prostate cancer, and one nasopharyngeal cancer (NPC) were noted. 7. Both of the HCC patients died of local and distant metastasis 3 months after DDLT from bone metastasis and about 3 years after transplantation respectively.

Conclusion: No significant difference in survival between cancer and non-cancer patients. We considered thorough preoperative screening for the possible small or occult cancer is fundamental to prevent poor prognosis.

LU MING CHI DR.

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