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World J Gastroenterol. Jan 7, 2016; 22(1): 427-434
Published online Jan 7, 2016. doi: 10.3748/wjg.v22.i1.427
Solid, non-skin, post-liver transplant tumors: Key role of lifestyle and immunosuppression management
Christophe Carenco, Stéphanie Faure, José Ursic-Bedoya, Astrid Herrero, Georges Philippe Pageaux
Christophe Carenco, Stéphanie Faure, José Ursic-Bedoya, Astrid Herrero, Georges Philippe Pageaux, Liver Transplant Unit, CHRU Montpellier, 34090 Montpellier, France
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Georges Philippe Pageaux, Professor, Liver Transplant Unit, CHRU Montpellier, 191 Avenue du Doyen Gaston Giraud, 34090 Montpellier, France. gp-pageaux@chu-montpellier.fr
Telephone: +33-4-67337061 Fax: +33-4-99632247
Received: September 1, 2015
Peer-review started: September 1, 2015
First decision: September 29, 2015
Revised: October 18, 2015
Accepted: November 13, 2015
Article in press: November 13, 2015
Published online: January 7, 2016
Processing time: 121 Days and 12.1 Hours
Abstract

Liver transplantation has been the treatment of choice for end-stage liver disease since 1983. Cancer has emerged as a major long-term cause of death for liver transplant recipients. Many retrospective studies that have explored standardized incidence ratio have reported increased rates of solid organ cancers post-liver transplantation; some have also studied risk factors. Liver transplantation results in a two to five-fold mean increase in the rate of solid organ cancers. Risk of head and neck, lung, esophageal, cervical cancers and Kaposi’s sarcoma is high, but risk of colorectal cancer is not clearly demonstrated. There appears to be no excess risk of developing breast or prostate cancer. Environmental risk factors such as viral infection and tobacco consumption, and personal risk factors such as obesity play a key role, but recent data also implicate the role of calcineurin inhibitors, whose cumulative and dose-dependent effects on cell metabolism might play a direct role in oncogenesis. In this paper, we review the results of studies assessing the incidence of non-skin solid tumors in order to understand the mechanisms underlying solid cancers in post-liver transplant patients and, ultimately, discuss how to prevent these cancers. Immunosuppressive protocol changes, including a calcineurin inhibitor-free regimen, combined with dietary guidelines and smoking cessation, are theoretically the best preventive measures.

Keywords: Liver transplantation; Tumors; Calcineurin inhibitors; Immunosuppression; Risk factors; Tacrolimus; Review; Incidence

Core tip: Liver transplantation results in two to five-fold mean increase in the rate of solid organ cancers. In this paper, we review the results of studies assessing the incidence of non-skin solid tumors in post-liver transplant patients to understand the mechanisms underlying solid cancers in these patients, and discuss how to prevent these cancers. Risk of smoking and viral-related malignancies is high, but recent data also implicate the role of calcineurin inhibitors, whose cumulative and dose-dependent effects on cell metabolism might play a direct role in oncogenesis.