肝移植术后新发恶性肿瘤四例临床分析

目的 探讨肝移植术后新发恶性肿瘤的临床特征、危险因素和防治措施.方法 回顾性分析2003年8月至2008年12月间行肝移植术的726例受者中新发恶性肿瘤的临床资料.结果 在726例肝移植受者中,术后新发恶性肿瘤4例,发生率为0.6%;患者均为男性;新发恶性肿瘤的类型分别为:急性髓性白血病、胃癌、肺癌和未分化肝肉瘤;患者肝移植时年龄为42～57岁,中位年龄52岁,肿瘤确诊时的年龄为45～60岁,中位年龄53岁;从接受肝移植手术至发生肿瘤的时间为6～38个月,中位时间31个月.4例患者均死于肿瘤进展和多器官功能衰竭.肝移植术至死亡时间为12～48个月,中位时间39.5个月;确诊为新发恶性肿瘤至死亡时间为6～10个月,中位时间8.5个月.结论 肝移植术后新发恶性肿瘤国内发病率低于国外;确诊时间较晚是患者死亡的主要原因;重视癌前病变和高危因素,早期诊断,早期治疗是提高疗效的关键.     

肝移植术后新发恶性肿瘤四例临床分析

目的 探讨肝移植术后新发恶性肿瘤的临床特征、危险因素和防治措施.方法 回顾性分析2003年8月至2008年12月间行肝移植术的726例受者中新发恶性肿瘤的临床资料.结果 在726例肝移植受者中,术后新发恶性肿瘤4例,发生率为0.6%;患者均为男性;新发恶性肿瘤的类型分别为:急性髓性白血病、胃癌、肺癌和未分化肝肉瘤;患者肝移植时年龄为42～57岁,中位年龄52岁,肿瘤确诊时的年龄为45～60岁,中位年龄53岁;从接受肝移植手术至发生肿瘤的时间为6～38个月,中位时间31个月.4例患者均死于肿瘤进展和多器官功能衰竭.肝移植术至死亡时间为12～48个月,中位时间39.5个月;确诊为新发恶性肿瘤至死亡时间为6～10个月,中位时间8.5个月.结论 肝移植术后新发恶性肿瘤国内发病率低于国外;确诊时间较晚是患者死亡的主要原因;重视癌前病变和高危因素,早期诊断,早期治疗是提高疗效的关键.     

肝移植术后新发肺癌1例临床分析附文献复习

目的探讨肝移植术后新发肺癌的临床特点、危险因素、预防及治疗。方法回顾性分析2003年10月至2009年12月间接受肝移植术的726例受者中的1例新发肺癌病例的临床资料。结果该院肝移植术后新发肺癌发生率0.14%（1/726）。该例为男性,肝移植时年龄为57岁,从接受肝移植手术至发生肿瘤历时26个月,从确诊新发肺癌至死亡历时10个月,死于肿瘤进展、多器官功能衰竭。结论肝移植术后新发肺癌的发生率较低;确诊时间较晚,疗效不佳;重视肝移植术后随访,早期诊断和早期治疗新发肺癌是提高疗效的关键措施。     

肝移植术后新发恶性肿瘤的治疗

目的 了解肝移植术后新发恶性肿瘤的发病情况,探讨新发恶性肿瘤的治疗方法.方法 回顾性分析2000年5月至2008年12月在我院实施肝移植手术并且随访时间超过半年的475例肝移植患者资料.结果 475例患者中有5例患者出现新发恶性肿瘤,发病率为1.1％.从肝移植手术到诊断恶性肿瘤的时间6 ～72个月,中位时间14个月.本组新发恶性肿瘤患者均为男性,包括直肠癌1例,经手术治疗痊愈;肝癌2例,发病后14个月和6个月死亡;肺神经内分泌癌伴肉瘤样分化1例,发病后16个月死亡;Bukitt淋巴瘤1例,发病后2个月死亡.结论 肝移植术后的新发恶性肿瘤较为少见但预后极差,早期发现和治疗是改善预后的关键.     

肾移植术后新发恶性肿瘤临床分析

目的探讨肾移植术后新发恶性肿瘤的临床特征。方法回顾性分析2001年6月至2005年1月在中山大学附属第五医院行‘肾移植术后生存半年以上并能接受定期随访的236例受者中新发恶性肿瘤患者的临床资料。结果在236例肾移植受者中,共有新发恶性肿瘤5例,发生率2．1％（5／236）。患者均为男性,新发肿瘤类型分别为直肠癌2例、肺癌1例、移行细胞癌1例、非霍奇金淋巴瘤1例。患者肾移植时年龄为46—70岁,平均年龄61岁,肿瘤确诊时的年龄为48～73岁,平均年龄65岁;从接受。肾移植手术至发生肿瘤的时间为14～77个月,平均时间46个月。5例患者经确诊为新发恶性肿瘤后,给予手术治疗和（或）化学药物治疗及减少免疫抑制剂或者转换免疫抑制方案治疗,均未发生肾功能异常和排斥反应。其中2例患者死于肿瘤进展和多器官功能衰竭,3例存活。结论 肾移植术后新发恶性肿瘤进展隐匿迅速,早期诊断、早期治疗是提高其疗效的关键措施。     

肝移植术后新发食管癌1例临床分析并文献复习

目的探讨肝移植术后新发食管癌的发病情况、危险因素、预防及治疗。方法对2003年8月至2008年12月中山大学附属第三医院肝移植中心行肝移植术后生存半年以上并能接受定期随访的416例受者,观察其新发恶性肿瘤的情况,分析新发食管癌患者的临床资料,同时进行文献复习。结果该中心肝移植术后新发食管癌1例,发生率为0．24％（国外平均发生率为0．11％）。该例男性患者肝移植时年龄为49岁,术前有长期吸烟史和嗜酒史,术后不完全戒酒、戒烟,术后46个月发现食管癌,从确诊新发食管癌至死亡历时10个月,死于肿瘤进展、多器官功能衰竭。结论烟酒史、免疫抑制过强是肝移植术后新发恶性肿瘤的危险因素,针对高危因素进行规范随诊以及优化免疫抑制方案,是早期防治和提高疗效的关键。     

肝移植术后新发恶性肿瘤的临床特征研究

目的研究肝移植术后新发恶性肿瘤的临床特征。方法选取2005年1月至2021年4月于青岛大学附属医院器官移植中心规律随访的成人肝脏移植患者作为研究对象, 回顾性分析新发恶性肿瘤的类型和临床特征。共纳入601例成人肝移植受者, 其中女性105例, 男性496例, 年龄(51.4±9.6)岁。以随访期间内是否合并新发恶性肿瘤将601例肝移植受者分为新发恶性肿瘤组(n=26)和非新发恶性肿瘤组(n=575)。收集患者年龄、性别、肝移植术前基础疾病、手术时间等临床资料。以门诊复查的方式随访。结果共有26例患者被诊断为肝移植术后新发恶性肿瘤, 共计28例次(其中2例患者为2次发现不同的新发恶性肿瘤), 肝移植术后新发恶性肿瘤的发病率为4.3%(26/601)。肝移植手术到诊断新发恶性肿瘤的中位时间为42(20, 70)个月。肝移植术后1、3、5、10、15年新发恶性肿瘤的累积发病率分别为0.5%、2.0%、6.3%、21.0%、34.5%。在28例次新发恶性肿瘤中, 消化系统肿瘤最多, 共17例次(60.7%), 其次是肺癌3例次(11.1%), 淋巴系统增殖性疾病2例次(7.4%), 宫颈癌、甲...     

肝移植术后新发胃癌1例临床分析附文献复习

目的 总结肝移植术后新发胃癌的诊治经验.方法 回顾性分析2003年8月至2009年12月间在中山大学附属第三医院共实施肝移植术726例,其中1例肝移植术后新发胃癌病例回顾该例临床资料,并进行文献复习.结果 该院肝移植术后新发胃癌发生率0.14 %(1/726).患者男性,肝移植时年龄为57岁,诊断肿瘤时年龄为59岁.从...     

肝移植术后新发肺癌的护理体会

目的:探讨肝移植术后新发肺癌的临床特征,并总结相关的护理经验和体会.方法:回顾性研究我院1例肝移植术后新发肺癌的资料.结果:肝移植术后患者从手术到发生肿瘤历时25个月,从确诊新发肺癌到死亡时间历时5个月,死于肿瘤进展,多器官衰竭.结论:肝移植术后新发肺癌临床早期诊断和早期治疗是提高疗效的关键,针对肺癌的临床特征,采取有针对性护理措施,从而提高生活质量.     

肝移植治疗原发性肝癌切除术后肝内复发七例

目的 探讨对原发性肝癌切除术后肝内复发患者进行肝移植手术的适应证和围手术期的治疗经验.方法 回顾性分析2000年9月至2005年9月间7例原发性肝癌切除术后肝内复发的患者接受原位肝移植治疗的临床资料,其中男性6例,女性1例,平均年龄43.7岁,肝移植术前均经病理学检查确诊为原发性肝癌,肿瘤组织学分级为高、中分化,肝癌切除术后无瘤期为6～31个月,均未发生肿瘤细胞侵犯大血管和肝外转移.所有患者均采用改良背驮式肝移植术.术后采用他克莫司(或西罗莫司)+霉酚酸酯+激素的三联免疫抑制方案.观察肝移植术后受者并发症及存活率情况.总结肝移植治疗原发性肝癌切除术后肝内复发的经验.结果 所有受者肝移植手术过程顺利,围手术期无死亡.1例术后22 h发生腹腔出血,1例术后13 d发生腹腔感染,1例术后4个月发生门静脉血栓,其余未发生严重并发症,7例受者均顺利出院.有3例受者分别于移植术后9、13及19个月时,因肿瘤复发而死亡,其余4例均长期无瘤存活,最长已达52个月.受者的1、2年存活率分别为85.7%和57.1%.结论 肝移植能有效治疗原发性肝癌切除术后肝内复发,受者适应证的选择和围手术期的辅助治疗非常关键.     

Incidence of de novo nonmelanoma skin tumors after liver transplantation for alcoholic and nonalcoholic liver diseases

INTRODUCTION: Skin tumors are the most common malignancies after orthotopic liver transplantation (OLT). They have been related to sunlight exposure, tobacco consumption, and immunosuppression. The aim of this study was to compare the incidence of de novo skin tumors (nonmelanoma) in patients who underwent liver transplantation for alcoholic cirrhosis versus nonalcoholic diseases. PATIENTS AND METHODS: Between April 1986 and July 2004, we performed 1000 OLT in a population of 888 recipients. This study was performed in a sample of 701 adult recipients who survived >2 months after transplantation: 276 patients (39.4%) underwent OLT for alcoholic cirrhosis (AC-group), and 425 (60.6%) for nonalcoholic disease (N-AC). The overall incidence of de novo skin tumors was 3.5% (25 tumors): 5.4% (15 tumors) in the AC-group and 2.4% (10 tumors) in the N-AC group (P = .027). Two patients developed two tumors. There were 19 men and 4 women, mean age at OLT of 54.4 +/- 6.8 years (range, 40 to 66 years). The mean time from OLT to tumor diagnosis was 66.1 +/- 51.4 months (range, 3 to 165 months): 56.4 +/- 44.4 months in the AC-group versus 80.6 +/- 59.8 months in the N-AC group (P = NS). Histologically, 17 tumors (68%) were basal cell carcinomas and eight tumors (32%) were squamous cell carcinomas (P = .128). Fourteen patients (60.8%) were smokers: 11 patients (84.6%) in the AC-group versus 3 patients (30%) in the N-AC group (P = .012). All the patients underwent tumor resection, with only one patient dying, because of lymph node invasion of the neck. CONCLUSION: There was a higher incidence of de novo skin tumors among patients who smoked who underwent OLT for alcoholic cirrhosis.     

Incidence and risk factors of development of lung tumors after liver transplantation

INTRODUCTION: Lung tumors have been related to tobacco and alcohol. The incidence increases after orthotopic liver transplantation (OLT) especially when it is performed because of alcoholic cirrhosis. PATIENTS AND METHODS: We analyzed the incidence and risk factors for de novo lung tumors among 701 patients who underwent OLT between April 1986 and July 2004, after exclusion of pediatric recipients and adults who died within 2 months after OLT. RESULTS: The incidence of de novo lung tumors was 15 patients (2.1%), including 12 (4.3%) who underwent OLT for alcoholic cirrhosis and 3 (0.7%) for nonalcoholic diseases. There were 14 men and 1 woman of mean age at OLT of 50.8 +/- 9.6 years. Mean time from OLT to lung tumor was 83 +/- 43 months (range, 10-184 months). Thirteen patients (86.6%) were heavy smokers before OLT and 8 (61.5%) continued after OLT; 12 patients (80%) were heavy drinkers before OLT. Ten patients were immunosuppressed with CyA and 5 with tacrolimus. Acute rejection episodes before tumor diagnosis occurred in 6 patients (40%). Two patients underwent thoracotomy, but only one was resected. The remaining 13 patients were unresectable because of locally advanced tumor or metastatic disease. Two unresectable patients received palliative chemotherapy. All patients died with a mean survival from tumor diagnosis, of 5.3 months (range, 3 days to 33 months). CONCLUSION: A significantly higher incidence of lung tumors was observed among patients who underwent OLT for alcoholic cirrhosis, usually diagnosed in advanced stages of poor prognosis and low survival.     

Upper aerodigestive tract and lung tumors after liver transplantation

BACKGROUND: The purpose of this study was to analyze the incidence, clinical characteristics, treatment, and outcome of upper aerodigestive (UAD) and lung de novo tumors after ortothopic liver transplantation (OLT). PATIENTS AND METHODS: Between April 1986 and June 2002, we performed 851 OLT in 753 patients. We excluded pediatric, partial, and hepatorenal transplants and recipients who died within 2 months after OLT. Thus, we analyzed the incidence and outcome of these tumors in 605 patients after OLT. RESULTS: We found 21 (3.5%) tumors in 20 (3.3%) recipients: 14 were UAD tumors (three in floor of the mouth, two in tonsil, one in tongue, one in pharynx, three in larynx, and four in esophagus) and seven were lung tumors. Nineteen patients were men and one was a woman, with a mean age at transplantation of 47.7+/-8.6 years. Mean time from OLT to tumor diagnosis was 61.7+/-35.1 years. As risk factors, 70% were heavy smokers, 75% were heavy drinkers, and 70% developed acute rejection. The incidence of these tumors was significantly higher in transplanted patients for alcoholic cirrhosis compared to the nonalcoholic cirrhosis (8.1% vs 0.8%; P<.0001). After surgical excision in 65% of patients, 1-, 2-, and 3-year patient survival were 47.6%, 37.0%, and 19.7%, respectively. CONCLUSION: There is a significantly higher incidence of these tumors in male heavy drinkers and/or smokers who underwent OLT for alcoholic cirrhosis; in spite of aggressive surgical treatment, the prognosis is poor.     

Indications and Management of Everolimus After Liver Transplantation

Objective

Our aim was to assess our experience with the use and management of everolimus after orthotopic liver transplantation (OLT).

Materials and Methods

Among the 759 patients who underwent transplantation from 1988 to 2008, 25 (3.2%) received immunosuppression with everolimus. Their mean age was 55.6 years. We analyzed indications for use, time between transplantation and introduction of everolimus, as well as its efficacy, side effects, and patient survival.

Results

The indications for everolimus treatment were: extended hepatocellular carcinoma (HCC) in the explanted liver (n = 6; 24%); HCC recurrence during follow-up (n = 4; 16%); de novo tumor (n = 6; 24%); refractory rejection (n = 3; 12%); side effects of calcineurin inhibitors (CNI; n = 3; 12%); and other causes (n = 3; 12%). Mean time between OLT and everolimus treatment was 40 ± 33 months (range, 10 days-178 months). Mean follow-up after conversion was 10 ± 9 months (range, 1.5-25 months). More than half of the patients resolved the event for which the drug was indicated: 75% of patients with refractory rejection; 60% of those with renal insufficiency; and 100% of those converted for neurotoxicity or hepatotoxicity. Two patients with recurrent HCC and 1 with extended HCC died at a mean time of 10.5 months. The 6 cases of de novo tumors were operated and are healthy. Side effects were dyslipidemia in 8 and infection in 2. Five patients (20%) discontinued the drug.

Conclusions

In the early posttransplantation period, everolimus is indicated for refractory rejection or as prophylaxis for recurrence of extended tumors. In any time but especially in the late period, everolimus is indicated for patients with serious side effects due to a CNI or to a de novo tumor.     

Incidence of Upper Aerodigestive Tract Cancer After Liver Transplantation for Alcoholic Cirrhosis: A 10-Year Experience in an Italian Center

Introduction

The aim of this study was to evaluate the incidence, clinical characteristics, treatment, and outcome of de novo tumors (DNT) of the upper aerodigestive tract in patients with alcoholic cirrhosis after orthotopic liver transplantation (OLT).

Methods

Among 225 consecutive OLT performed between January 2002 and January 2012, a total of 205 patients received a first liver allograft. Eleven (4.9%) patients developed DNT (lung, pancreas, bowel, esophagus, larynx, tongue, tonsil, and lymphoma). Among these, we observed 5 patients with DNT of the upper aerodigestive tract.

Results

The 5 patients with DNT of the upper aerodigestive tract underwent OLT for alcoholic cirrhosis. There were 4 men and 1 woman with a mean age at transplantation of 47 years. The mean period of alcohol abuse was 90 months. The tumors occurred after a mean post-transplantation time of 39 months. The immunosuppressive regimen included Tacrolimus, mTOR, mycophenolate mofetil (MMF), and low-dose steroids. We observed 2 cases of squamous cell carcinoma of the esophagus, 1 case of tonsillar cancer, 1 case of larynx carcinoma, and 1 case of tongue carcinoma. All patients underwent surgical excision. After surgery, 4 patients received chemotherapy and 2 patients radiotherapy. At present, among the 5 patients with DNT of the upper aerodigestive tract, only 2 are alive without disease and 1 is alive with a local recurrence.

Conclusion

The incidence of DNT of the upper aerodigestive tract after OLT is higher among patients receiving a transplant for alcoholic cirrhosis. This could be due to an additional effect of post-transplantation immunosuppression in patients exposed to alcohol before transplantation. We suggest a careful post-transplantation follow-up and more attention to improve early diagnosis.