De novo malignancies after intestinal and multivisceral transplantation

Kareem M. Abu-Elmagd, Marsha Zak, June M. Stamos, Geoff J. Bond, Ashok Jain, Ada O. Youk, Mohamed Ezzelarab, Guilherme Costa, Tong Wu, Michael A. Nalesnik, George V. Mazariegos, Rakesh K. Sindhi, Amadeo Marcos, Anthony J. Demetris, John J. Fung, Jorge D. Reyes

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24 Scopus citations

Abstract

Background. Maintenance immunosuppression required after organ transplantation creates a permissive environment in which cancer cells can proliferate because of lack of natural immunologic surveillance. With more than a decade of clinical experience, this report is the first to address the risk of de novo cancer after intestinal transplantation. Methods. A total of 168 consecutive intestinal transplant recipients (86 children and 82 adults) were studied, of whom 52% were male and 91% were white. Surveillance, Epidemiology, and End Results data was used to count expected rates of de novo cancers in the general population matched for age, sex, and length of follow-up. Results. With a mean follow-up of 47±41 months, 7 (4.2%) patients developed nonlymphoid de novo cancer, with a cumulative risk of 3% at 5 years and 28% at 10 years. Of these malignancies, one was donor-driven adenocarcinoma. With 0.58 being the expected rate of malignancy for the general population, the risk among intestinal recipients was 8.7 times higher (P=0.01). Such morbidity was significantly higher (50 times) among younger patients (<25 years), with a slight male preponderance. Induction immunosuppression was associated with early onset of de novo cancer. Patient survival after diagnosis of de novo cancer was 72% at 1 year, 57% at 2 years, and 29% at 5 years. Conclusion. With conventional immunosuppression, intestinal recipients are at a significantly higher risk of developing de novo cancer when compared with the general population. Thus, a novel tolerogenic immunosuppressive strategy has been recently implemented to reduce the lifelong need for immunosuppression.

Original languageEnglish (US)
Pages (from-to)1719-1725
Number of pages7
JournalTransplantation
Volume77
Issue number11
DOIs
StatePublished - Jun 15 2004

All Science Journal Classification (ASJC) codes

  • Transplantation

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    Abu-Elmagd, K. M., Zak, M., Stamos, J. M., Bond, G. J., Jain, A., Youk, A. O., Ezzelarab, M., Costa, G., Wu, T., Nalesnik, M. A., Mazariegos, G. V., Sindhi, R. K., Marcos, A., Demetris, A. J., Fung, J. J., & Reyes, J. D. (2004). De novo malignancies after intestinal and multivisceral transplantation. Transplantation, 77(11), 1719-1725. https://doi.org/10.1097/01.TP.0000131164.43015.4B