TY - JOUR

T1 - Decreasing incidence of cancer after liver transplantation

T2 - A Nordic population-based study over 3 decades

AU - Nordin, A.

AU - Åberg, F.

AU - Pukkala, E.

AU - Pedersen, C. R.

AU - Storm, H. H.

AU - Rasmussen, A.

AU - Bennet, W.

AU - Olausson, M.

AU - Wilczek, H.

AU - Ericzon, B. G.

AU - Tretli, S.

AU - Line, P. D.

AU - Karlsen, T. H.

AU - Boberg, K. M.

AU - Isoniemi, H.

PY - 2018

Y1 - 2018

N2 - Cancer remains one of the most serious long-term complications after liver transplantation (LT). Data for all adult LT patients between 1982 and 2013 were extracted from the Nordic Liver Transplant Registry. Through linkage with respective national cancer-registry data, we calculated standardized incidence ratios (SIRs) based on country, sex, calendar time, and age-specific incidence rates. Altogether 461 cancers were observed in 424 individuals of the 4246 LT patients during a mean 6.6-year follow-up. The overall SIR was 2.22 (95% confidence interval [CI], 2.02-2.43). SIRs were especially increased for colorectal cancer in recipients with primary sclerosing cholangitis (4.04) and for lung cancer in recipients with alcoholic liver disease (4.96). A decrease in the SIR for cancers occurring within 10 years post-LT was observed from the 1980s: 4.53 (95%CI, 2.47-7.60), the 1990s: 3.17 (95%CI, 2.70-3.71), to the 2000s: 1.76 (95%CI, 1.51-2.05). This was observed across age- and indication-groups. The sequential decrease for the SIR of non-Hodgkin lymphoma was 25.0-12.9-7.53, and for nonmelanoma skin cancer 80.0-29.7-10.4. Cancer risk after LT was found to be decreasing over time, especially for those cancers that are strongly associated with immunosuppression. Whether immunosuppression minimization contributed to this decrease merits further study.

AB - Cancer remains one of the most serious long-term complications after liver transplantation (LT). Data for all adult LT patients between 1982 and 2013 were extracted from the Nordic Liver Transplant Registry. Through linkage with respective national cancer-registry data, we calculated standardized incidence ratios (SIRs) based on country, sex, calendar time, and age-specific incidence rates. Altogether 461 cancers were observed in 424 individuals of the 4246 LT patients during a mean 6.6-year follow-up. The overall SIR was 2.22 (95% confidence interval [CI], 2.02-2.43). SIRs were especially increased for colorectal cancer in recipients with primary sclerosing cholangitis (4.04) and for lung cancer in recipients with alcoholic liver disease (4.96). A decrease in the SIR for cancers occurring within 10 years post-LT was observed from the 1980s: 4.53 (95%CI, 2.47-7.60), the 1990s: 3.17 (95%CI, 2.70-3.71), to the 2000s: 1.76 (95%CI, 1.51-2.05). This was observed across age- and indication-groups. The sequential decrease for the SIR of non-Hodgkin lymphoma was 25.0-12.9-7.53, and for nonmelanoma skin cancer 80.0-29.7-10.4. Cancer risk after LT was found to be decreasing over time, especially for those cancers that are strongly associated with immunosuppression. Whether immunosuppression minimization contributed to this decrease merits further study.

KW - cancer/malignancy/neoplasia: registry/incidence

KW - cancer/malignancy/neoplasia: risk factors

KW - clinical research/practice

KW - liver transplantation/hepatology

U2 - 10.1111/ajt.14507

DO - 10.1111/ajt.14507

M3 - Journal article

C2 - 28925583

AN - SCOPUS:85031490474

VL - 18

SP - 952

EP - 963

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 4

ER -