Decreasing incidence of cancer after liver transplantation—A Nordic population‐based study over 3 decades |
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| Authors: | A Nordin F Åberg E Pukkala C R Pedersen H H Storm A Rasmussen W Bennet M Olausson H Wilczek B‐G Ericzon S Tretli P‐D Line T H Karlsen K M Boberg H Isoniemi |
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| Affiliation: | 1. Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, Finland;2. Finnish Cancer Registry – Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland;3. Faculty of Social Sciences, University of Tampere, Tampere, Finland;4. Department of Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark;5. Danish Cancer Society, Copenhagen, Denmark;6. Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden;7. Division of Transplantation Surgery, Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden;8. The Norwegian Cancer Registry, Oslo, Norway;9. Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway;10. Institute of Clinical Medicine, University of Oslo, Oslo, Norway;11. Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway;12. Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway |
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| Abstract: | 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. |
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| Keywords: | cancer/malignancy/neoplasia: registry/incidence cancer/malignancy/neoplasia: risk factors clinical research/practice liver transplantation/hepatology |
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