高龄膀胱癌患者全膀胱切除术19例报告

目的探讨高龄（≥75岁）浸润性膀胱癌患者行全膀胱切除术的可行性及疗效。方法1985年1月至2002年1月收治高龄（≥75岁）浸润性膀胱癌行全膀胱切除术患者19例，均为男性，平均年龄78岁。从手术时间、术中输血、术后并发症、生存率等方而与同期202例浸润性膀胱癌（〈75岁，对照组）行全膀胱切除术患者进行比较。结果高龄组平均手术时间414min，平均术中输血1550ml，平均术后住院时间24d，对照组分别为366min，1200ml，19d，2组比较差异无统计学意义（P〉0．05）。高龄组和对照组术后近期并发症分别为9例（47．4％）、28例（13．9％），P〈0．05。高龄组13例获随访，1、5年生存率分别为66．7％（8／12）、50．0％（3／6）。对照组138例获得随访，1、5年生存率分别为90．4％（113／125）、68．4％（52／76）。高龄组患者1年生存率明显低于对照组（P〈0．05），而5年生存率比较差异无统计学意义（P〉0．05）。结论全膀胱切除术可以安全地应用于适当选择的高龄患者，年龄不应成为高龄浸润性膀胱癌患者行根治性全膀胱切除术的排除标准。     

多学科协作诊治模式下老年结直肠癌患者应用新辅助化疗联合手术治疗的临床效果

目的探讨在多学科协作（multi—disciplinary team，MDT）诊治模式下，新辅助化疗联合手术的综合治疗策略在老年人群中应用的安全性和临床差异性。方法回顾性研究2007年6月～12月期间就诊于四川大学华西医院肛肠外科专业组的结直肠癌患者的资料，分析比较老年组（≥60岁）和非老年组（〈60岁）之间应用综合治疗策略的临床疗效差异。结果在术前指标中，老年组患者合并心血管系统、内分泌系统以及其他系统疾病的构成比均明显高于非老年组（P〈0．05），其中老年组术前患有高血压和糖尿病患者的构成比均明显高于非老年组（P〈0．05），其余术前指标差异无统计学意义（P〉0．05）。各项术中指标的差异在2组间均无统计学意义（P〉0．05）。而在术后指标中，老年组术后并发症发生率高于非老年组（P〈0．05），老年组患者术后拔除胃管、尿管和引流管的时间和非老年组之间的差异无统计学意义（P〉0．05）；同时老年组患者术后进食时间、经肛门排气／排便时间以及下床活动时间与非老年组比较，差异也无统计学意义（P〉0．05）。在化疗相关并发症方面，2组间差异也无统计学意义（P〉0．05）。结论尽管老年患者可能术前基础情况更差、治疗难度更大，但新辅助化疗联合手术的综合治疗策略并不会导致老年组患者手术治疗的延误，而且手术干预过程中的术式选择也并不会受到影响，术后近期治疗效果满意。因此在老年群体中应用该策略是具有一定临床效果和安全性的。     

肝移植术后神经精神并发症的临床诊治

目的探讨肝移植术后神经精神并发症的诊断、病因和防治：方法回顾性分析127例肝移植患者的临床资料,分析肝移植术后神经精神并发症的发生原因结果有症状组和无症状组在年龄上相比较差异无统计学意义（P〉0．05）;但在性别、手术时间、术前血氨水平、术中输血量、血总胆红素、血肌酐、住ICU时间．免疫抑制剂浓度、术后感染等方面,两组相比较,差异有统计学意义（P〈0．01）：结论肝移植术后神经精神并发症的发生率较高,病因及临床表现形式多样,需积极预防及时处理,提高肝移植手术的效果。     

乙型肝炎病毒感染及肝硬化与结直肠癌肝转移的关系

目的探讨乙型肝炎病毒（HBV）感染和肝硬化与结直肠癌肝转移的关系。方法回顾北京大学临床肿瘤学院外科1999年1月至2004年8月收治的1176例结直肠癌患者的临床及随访资料,分析HBV感染和肝硬化对肝转移发生率及患者预后的影响。结果有和无HBV感染的两组结直肠癌患者肝转移发生率分别为8.8％（10／114）和23．9％（254／1062）。差异有统计学意义（P〈0．01）;两组患者的5年生存率分别为54．2％和60．7％．差异无统计学意义（P〉0．05）。伴和不伴肝硬化的两组结直肠癌患者肝转移发生率分别为3．8％（1／26）和22．9％（263／1150）．差异有统计学意义（P〈0．05）;两组患者5年生存率分别为60．9％和59．9％,差异无统计学意义（P〉0．05）。结论HBV感染和肝硬化可降低结直肠癌患者肝转移的发生率．但并不影响其生存率。     

自制单孔腹腔镜与显微外科治疗精索静脉曲张的临床疗效及并发症对比

目的比较自制单孔腹腔镜手术与显微外科手术治疗精索静脉曲张的临床疗效及并发症。方法回顾性收集83例精索静脉曲张患者临床资料,其中显微外科组40例,自制单孔腹腔镜组43例,比较两种术式手术时间、术后住院日、术前与术后3个月的精液质量分析以及术后并发症发生率。结果显微外科组手术时间较长（P〈0．05）,两组术后住院日无统计学差异（P〉0．05）,两组术后精子活率、精子活力、精子密度均较术前明显提高（P〈0．05）,显微外科组精子活率、精子活力均较高（P〈0．05）,两组精子密度无统计学差异（P〉0．05）;显微外科组术后阴囊水肿发生较低（P〈0．05）;两组术后复发率无统计学差异（P〉0．05）。结论自制单孔腹腔镜精索静脉结扎术及显微外科精索静脉结扎术均具有创伤小、恢复快、复发率低的优点,但显微外科组患者恢复更快、并发症更少,是更值得推广的安全有效的术式。     

ERCP和PTC介入治疗肝移植术后胆道并发症的作用比较

目的比较ERCP和PTC介入治疗肝移植术后胆道并发症的作用和疗效。方法回顾性分析2004年8月至2006年8月44例接受介入治疗的肝移植术后胆道并发症患者临床资料，比较ERCP和PTC介入治疗在肝移植术后胆道并发症中的疗效和并发症。结果首选ERCP介入治疗31例，3例操作失败（9．6％）；PTC介入治疗16例，均操作成功。胆道吻合口狭窄和非胆道吻合口狭窄ERCP和PTC介入治疗的治愈率分别为73．3％、77．7％和23．1％、14．3％，差异无统计学意义（P〉0．05）。两种介入治疗术后并发症的发生率差异无统计学意义（P〉0．05）。结论ERCP和PTC介入治疗肝移植术后胆道并发症的疗效和并发症的发生率相当，可以将PTC介入技术作为治疗肝移植术后胆道并发症的首选措施。     

腹腔镜辅助胃癌根治术在老年患者中的应用研究

目的探讨腹腔镜辅助胃癌D：根治术在老年患者应用中的可行性及临床疗效。方法回顾性分析2007年10月至2012年10月间在河南大学淮河医院接受腹腔镜辅助胃癌根治术的109例老年（70岁以上）进展期胃癌患者（腹腔镜组）的临床资料,并与同期开腹胃癌根治术的124例老年患者（开腹组）的临床资料进行对比分析。结果与开腹组相比,腹腔镜组患者术中出血量更少[（102．5±34．3）ml比（181．7±73．8）ml,P〈0．05],术后肠功能恢复更快[（2．8±0．6）d比（4．0±1．2）d,P〈0．05],术后住院时间更短[（10．7±7．5）d比（14．2±6．5）d,P〈0．05],术后并发症发生率更低[10．1％（11／109）比21．0％（26／124）,P〈0．05],但手术时间较长[（231．2±51．4）min比（208．5±53．6）min,P〈0．05],两组患者淋巴结清扫枚数相当（31．4±14．2比32．6±11．7,P〉0．05）。腹腔镜组术后短期生活质量明显优于开腹组（P〈0．05）。腹腔镜组和开腹组术后5年生存率分别为54．5％和59．2％,差异无统计学意义（P〉0．05）。结论老年患者行腹腔镜辅助胃癌根治术能达到与开腹手术相似的根治效果,且微创优势显著。     

MELD评分对肝移植手术患者预后的预测价值

目的探讨术前终末期肝病模型（model for end－stage liver disease,MELD）评分在肝移植治疗终末期肝病早期预后中的预测价值。方法回顾106例终末期肝病患者行肝移植治疗的临床资料,计算术前MELD评分,根据并发症、死亡检验ROC曲线中最佳曲线Youden指数最高时的MELD截断值进行分组,并对各组早期并发症发生率和生存率结果进行分析。结果本组106例肝移植患者中各种严重并发症发生率为29．25％,住院28d和术后3个月生存率分别为90．57％和89．62％;非并发症组、并发症组以及生存组、死亡组的MELD评分均值分别为12．00、21．19和13.28、28．27,其MELD分值差异有统计学意义（P〈0．01）：评价并发症的ROC曲线下面积为0．24±0．05（P〈0．01）,死亡检验ROC曲线下面积为0．87±0．06（P〈0．01）,死亡检验ROC曲线Youden指数最高时的MELD截断值分别为18.42和27．15;与MELD≤18．42组相比,18．42—27．15组和≥27．15组两组的并发症发生率、死亡率均显著增加（P〈0．01）。结论终末期肝病患者术前MELD评分分值越高,肝移植后早期严重并发症发生率和死亡率越高：MELD分值对行肝移植术的患者发生严重并发症的预测效果较差,但对死亡的预测效果较好：高分值MELD（≥27．15）是预测肝移植患者术后高并发症发生与死亡的较好指标。     

三种开窗引流术治疗老年先天性肝囊肿的回顾性对比研究

目的比较腹腔镜开窗网膜移植术、腹腔镜单纯开窗术和开腹单纯开窗术三种方法治疗年龄60岁及以上先天性肝囊肿的近远期疗效。方法回顾性分析74例老年先天性肝囊肿患者的临床资料,其中网膜组（腹腔镜开窗网膜移植术）25例,单纯组（腹腔镜单纯开窗术）28例,开腹组（开腹单纯开窗术）21例,比较三组的手术时间、术中失血量、禁食时间、下床活动时间、术后引流量、术后白细胞计数、住院时间、术后并发症发生率和复发率等。结果单纯组手术时间较网膜组、开腹组缩短（P〈0．05）。开腹组术中失血量、禁食时间、下床活动时间、术后白细胞计数、住院时间较腹腔镜组增多（P均〈0．05）。网膜组术后引流量和总并发症发生率较单纯组、开腹组减少（P均〈0．05）,但三组术后近期并发症发生率如术后出血、胸腔积液、肺部感染、腹水、胆漏等以及复发率、再手术率差异无统计学意义（P〉0．05）。结论针对老年先天性肝囊肿患者,腹腔镜开窗网膜移植术在减少术后引流量、降低总体并发症发生率上更具优势,腹腔镜单纯开窗术可缩短手术时间。     

高龄与中青年胃癌患者术后早期肠内营养的疗效对比

目的比较高龄（≥70岁）和中青年（〈60岁）胃癌患者术后早期肠内营养（EN）的临床疗效。方法回顾性地分析我院行胃癌根治术后接受早期EN的高龄80例和中青年61例患者的术后的胃肠道症状（恶心、呕吐等）和手术并发症发生率以及术后1周时的生化指标（白蛋白和前白蛋白水平等）的差别。结果与中青年患者相比,高龄患者接受早期EN可获得相似的疗效（P〉0．05）,但患者腹胀等胃肠道症状发生率较高（28．8％比13．1％,P〈0．05）,经降低营养液输注速度和提高温度后可控制该症状。结论早期EN同样适合于高龄胃癌患者,但需要更为精心的护理。     

The impact of donor variables on the outcome of orthotopic liver transplantation for hepatitis C

Morphologic characteristics of the graft have been proposed as a major contributor to the long-term outcomes in orthotopic liver transplantation (OLT). Our objective was to determine the impact of donor variables, including donor age, donor-recipient HLA match, and type of donation (DCD vs donation after brain death [DBD]), on the outcome of OLT in 192 patients with hepatitis C virus (HCV). Fourteen patients underwent OLT from donation after cardiac death (DCD) donors and 188 from DBD donors. Mean donor age, warm ischemia time at recovery, and cold ischemia time were similar between the groups. Overall graft survival rate at 1 year (55% DCD vs 85% DBD) and 5 years (46% DCD vs 78% DBD) was significantly lower in the DCD group (P = .0003). Similarly, patient survival rate at 1 year (62% DCD vs 93% DBD) and 5 years (62% DCD vs 82% DBD) was significantly lower in the DCD group (P = .0295). Incidences of hepatic artery thrombosis, portal vein thrombosis, and primary nonfunction were similar between the DCD and DBD groups. The incidence of liver abscess with ischemic-type biliary stricture was higher in recipients from DCD as compared with DBD (42% vs 2%). A trend toward lower graft survival was noted in recipients from donors older than 60 years of age in the HCV population (P = .07), with statistically lower patient survival (P = .02). Donor- recipient HLA matching did not appear to correlate with OLT outcome in patients with HCV. DCD donors and donors older than 60 years of age significantly impact patient and graft survival. Lower graft and patient survival in recipients from DCD donors does not appear to be related to early disease recurrence.     

Renal transplantation outcomes: a comparative analysis between elderly and younger recipients

Renal transplantation is presently the best treatment for end-stage renal disease, although considered contraindicated for elderly patients. However, more investigation is needed due to higher life expectancy rates of the general population and the increasing number of over 60-yr-old patients with chronic renal failure dependent upon dialysis. This study aims to determine graft and patient survival rates of renal transplant patients 60 yr and older compared to a younger group (50-59 yr old). Relevant pre- and post-transplant clinical data related to graft and patient survival in both groups were also investigated. Three-hundred and twenty consecutive renal transplant patients were enrolled in this study and grouped based on age at the time of the transplantation: one-hundred and ten patients at or over 60 yr old (elderly group) and 210 patients ranging from 50 to 59 yr old (younger group). There were no statistical differences in either group regarding clinical characteristics and immunological risk factors. The incidence of acute rejection was higher in the younger group (37.6%) than in the elderly (22.7%) (p = 0.01). Censored to death graft survivals at five yr were respectively 86.7% for patients > or = 60 yr and 82.1% for patients 50-59 yr old (p = 0.49). Patient survival rates at five yr were respectively 76.2% for patients > or = 60 yr and 81.6% for patients 50-59 yr old (p = 0.33). Our data show that renal transplantation for elderly patients has similar results to those found in younger individuals, which does not make age, in and of itself, a contraindication for transplantation.     

Male Patients Above Age 60 have as Good Outcomes as Male Patients 50–59 Years Old at 1-Year Follow-up After Bariatric Surgery

BACKGROUND: It is estimated that 25% of Americans older than 60 years are obese. Male gender and advanced age are indicators of increased risk for bariatric surgery. Good results have been shown in patients older than 50, but nearly all published studies include a large majority of females, and few include patients >60 years old. In this study, we examined the results of males over 60 years old. METHODS: We reviewed a prospective database of 107 consecutive patients who underwent bariatric surgery between April 2002 and June 2007 at the Palo Alto VA. Of these, 60 patients were males older than 50 and available for follow-up 12 months postoperatively. There were 47 males 50-59 years old (group I) and 13 males older than 60 years (group II). Data were analyzed using Student's t test. RESULTS: Mean preoperative body mass index was similar in both groups (49.4 vs. 47.5 kg/m(2); p = 0.468). Length of hospital stay was similar (3.2 vs. 3.5 days; p = 0.678), but early morbidity was higher in group II patients (30.8% vs. 8.5%; p = 0.037). Morbidity included urinary tract infection, cardiac arrhythmias, and early bowel obstruction. Excess weight loss after 1 year was not significantly different (63.6% vs. 60.6%; p = 0.565). Diabetes resolution or improvement was seen in 87% of group I patients and 90% of group II patients. CONCLUSION: Despite a higher early morbidity rate, obese males >/=60 years old perform as well as male patients 50-59 years old with respect to excess weight loss, mortality, length of stay, and improvement of diabetes, at 1 year postoperatively.     

Early mortality rates in older kidney recipients with comorbid risk factors

BACKGROUND: There are over 60,000 candidates on the deceased donor kidney wait-list and the percentage of candidates over age 50 years continues to grow each year. National data have not previously been used to evaluate the association of comorbidities with mortality in older patients. METHODS: A multivariate analysis of 30,262 deceased donor primary kidney recipients aged 18-59 years and 8,895 aged >or=60 years evaluated the association of six recipient comorbidities on 90- and 365-day patient mortality rates. The additional effects of expanded criteria donors (ECD) and development of delayed graft function (DGF) were also evaluated. RESULTS: The 365-day mortality rate for recipients aged >or=60 years (10.5%) was more than twice that of recipients aged 18-59 years (4.4%) and comorbidities significantly increased mortality rates even higher (10.6-21.4%). The 365-day mortality rate for recipients aged >or=60 years who received an ECD kidney was 14.4% and who developed DGF was 15.9% while recipients with comorbidities but no DGF and no ECD ranged from 16.0 to 42.3%. The 365-day transplant mortality rate of recipients aged >or=60 years with comorbidities is higher than the 365-day wait-list mortality for patients with the same comorbidities, suggesting a lack of survival benefit from transplantation. CONCLUSIONS: Mortality rates for patients aged >or=60 years with comorbidities are higher than for those without comorbidities, significantly higher than for younger patients, and higher than for wait-listed patients. Thus, utility may be poorly served by allocating kidneys to older patients with comorbidities, and perhaps discussion of exclusionary listing criteria is warranted.     

Donors older than 70 years in liver transplantation

INTRODUCTION: Expansion of donor criteria has become necessary with the increasing number of liver transplantation candidates, as aged donors who have been considered to yield marginal organs. METHODS: Our database of 477 liver transplants (OLT) included 55 cases performed from donors at least 70 years old vs 422 with younger donors. We analyzed pretransplantation donor and recipient characteristics as well as evolution of the recipients. RESULTS: The old donor group showed significantly lower ALT (23 +/- 17 vs 48.9 +/- 67; P = .0001) and LDH (444 +/- 285 vs 570 +/- 329; P = .01). There was a trend toward fewer hypotensive events in the aged donor group (27.2% vs 40.5%; P = .07). No steatosis (>10%) was accepted in the old donor group. Cold ischemia time was statistically shorter for the aged donors (297 +/- 90 minutes vs 346 +/- 139 minutes; P = .03). With these selected donors, the results were not different for primary nonfunction, arterial and biliary complications, hospitalization, acute reoperation or acute retransplantation, and hospital mortality when donors > or =70 years old were compared to younger donors. Functional cholestasis, neither related to rejection nor to biliary complications, was seen more frequently in old donor recipients (40% vs 22%; P = .03). No differences in 1, and 3 year survivals were observed between recipients of donors over 70 years old and these of younger organs: 93.8% and 90.6% vs 90.7% and 82.8%, respectively. CONCLUSION: When using selected donors > or =70 years old the outcomes were comparable to those obtained with younger donors. Strict selection is necessary to achieve good long-term survival.     

Predicting clinical outcome in the elderly renal transplant recipient

BACKGROUND: The purpose of this study was to evaluate graft and patient survival in first-time kidney transplant recipients 60 years old or older, and to identify pretransplant risk factors that predict clinical outcome. METHODS: We reviewed the clinical course of 206 recipients, 60 years old or older, of first kidney transplants at the University of Minnesota. Patient and graft survival were compared with 1640 patients aged 18 to 59 transplanted during the same time period. Regression analysis was performed to identify risk factors that predicted a poor outcome. RESULTS: In patients 60 years old or older, graft survival at one and five years was 86 and 60%, and patient survival at one and five years was 90 and 68%, respectively. Graft and patient survival were decreased compared with recipients aged 18 to 59, but were similar when censored for patient death as a cause of graft loss. A pretransplant history of nonskin malignancy and vascular disease and a current smoking history were risk factors for decreased graft and patient survival. To determine the potential impact of screening for low-risk patients, we evaluated graft and patient survival in patients age > or =60 without these risk factors versus those with one or more risk factors. In the absence of risk factors, both graft and patient survival were significantly improved compared with patients with these risk factors and were equivalent to that of patients aged 18 to 59. CONCLUSIONS: Renal transplantation is a safe and effective therapy for the older renal failure patient. In the absence of identified risk factors, graft survival is equivalent to that seen in younger patients.     

Incidence and recurrence of autoimmune/alloimmune hepatitis in liver transplant recipients

We prospectively collected data on 1,429 liver transplant recipients between December 1984 and December 1998. Fifty-five patients (3.8%; 10 men, 45 women; median age, 44.5 ± 13 [SD] years) with autoimmune hepatitis (AIH) underwent orthotopic liver transplantation (OLT). Transplant recipients with AIH were younger, more likely to be women, and had a greater likelihood of rejection in the first 3, 6, and 12 months. There was no difference in patient survival or graft survival. There were 11 biopsy-proven recurrences (1 man, 10 women) of AIH after OLT. Almost half the episodes occurred within the first year after OLT. No patient required re-OLT because of recurrent disease. AIH has an incidence of 4% and a recurrence rate of 20% in OLT. Transplant recipients are more likely to be young women and have an increased incidence of acute cellular rejection (ACR) during the first post-OLT year. Recurrence should be suspected in those with abnormal liver function test results in the absence of ACR, especially during the first year after OLT. We cannot establish with certainty whether the observed process represents recurrence of the original autoimmune disease, an alloimmune phenomenon, or allograft dysfunction mimicking AIH. (Liver Transpl 2002;8:519-526.)     

肝移植术后神经精神并发症的回顾分析

目的:回顾性分析60例肝移植受体术后神经精神并发症的诊治情况。方法:分析2001年4月至2003年8月60例肝脏移植者术后神经精神并发症的发生、病因、治疗反应及预后情况。结果:60例病人中21例(共23例次)曾有神经精神并发症表现。总发生率为38.3%。其中谵妄样精神障碍15例次(28.3%),癫痫2例(3.3%),昏迷2例(3.3%),肢体运动障碍1例(1.7%),颅内感染引起的头痛、呕吐1例(1.7%)。药物、脑出血、脑梗死、全身感染、颅内感染是相关的病因。16例谵妄样精神障碍及2例脑出血发生在术后1周内,1例颅内真菌感染发生在术后第6月。大部分并发症的治疗反应较好,而脑出血则是严重的移植后中枢神经系统并发症,预后很差。结论:肝移植术后神经精神并发症的发生率较高,大多数病例症状较轻,预后较好,但严重的并发症则死亡率很高。大部分并发症发生在术后早期,也有部分发生在晚期。有多种病因或易感因素。针对不同病因和及时、有效的处理能改善此类病人的预后。     

Risk stratification of adult patients undergoing orthotopic liver transplantation for fulminant hepatic failure

BACKGROUND: Orthotopic liver transplantation (OLT) is an effective treatment for fulminant hepatic failure (FHF), but postOLT mortality is higher for patients with FHF than for patients with other indications for OLT. In the current study, a large cohort of patients who underwent OLT for FHF was evaluated to develop and validate a system useful for estimating postOLT patient survival. METHODS: The 1,457 patients who underwent OLT for FHF in the United States between 1988 and 2003 were enrolled through the UNOS database. This group was divided into a modeling group (n=972) and a crossvalidation group (n=486). With a multivariate regression analysis, the modeling group was used to identify clinical parameters that had a significant association with postOLT survival. This regression analysis was used to create a scoring system that was subsequently assessed in the crossvalidation group. RESULTS: Four risk factors were identified with the multivariate analysis: 1) body mass index > or = 30 kg/m2; 2) serum creatinine > 2.0 mg/dL; 3) recipient age > 50 years old; and 4) history of life support. By assigning points based on the number of risk factors present, the scoring system was able to differentiate between low-risk patients (5-year survival, 81%) and high-risk patients (5-year survival, 42%). The relative risk of postOLT mortality increased by approximately 150% for each additional point. CONCLUSION: The scoring system risk-stratified the crossvalidation group and accurately predicted postOLT survival. A scoring system utilizing clinical and demographic information readily available prior to OLT may help predict the probability of survival after OLT for FHF.     

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.