Mousa, Omar Y.

INTRODUCTION: Immunocompromised liver transplant (LT) recipients are at increased risk of de novo malignancy. Data regarding oral and oropharyngeal malignancy following liver transplantation is limited, and recommendations for oral cancer screening are lacking. The impact of these malignancies on patient survival in the United Network for Organ Sharing (UNOS) database has not been assessed. We aim to evaluate the rates of oral and oropharyngeal malignancy among LT recipients in the US and estimate patient survival. METHODS: We examined the UNOS database and identified patients with oral and oropharyngeal malignancy who underwent LT between 1988 and 2016. Patients greater than 18 years of age were included. Kaplan-Meier survival analysis and log-rank tests were performed. RESULTS: In the UNOS database, survival data regarding 142,488 patients was available and the cause of death was identified in 14,533 LT recipients.83 patients had oral and oropharyngeal malignancy. 23 patients had cancer of the tongue and floor of the mouth. Mean age 55 years (SD ± 8), mean BMI 26 (SD ± 4), males were 74%, white 83%. 49 patients had tonsillar and oropharyngeal cancer. Mean age 54 years (SD ± 7), mean BMI 25 (SD ± 4), males were 86%, white 80%. 11 patients had oral and palate cancer. Mean age 56 years (SD ± 6), mean BMI 26 (SD ± 5), males were 55%, white 100%. Compared to all LT indications, those who developed oral and oropharyngeal malignancy were more likely to have alcoholic liver disease ( P < 0.001). The mean patient survival time in the study population ranged between 5 and 7.5 years. However, patient survival was significantly lower among patients who developed oral and oropharyngeal malignancy compared to other LT recipients (Log-rank test, P < 0.001) (Figure 1). CONCLUSION: Analysis of the UNOS database showed that oral and oropharyngeal malignancy is more common among male recipients with a history of alcoholic liver disease. Better outcomes should be expected if such patients were diagnosed earlier, prolonging their life expectancy. Having a history of heavy alcohol use should raise awareness among dentists, gastroenterologists and transplant physicians regarding the increased risk of oral cancers after LT.

INTRODUCTION: Solid organ transplant recipients are at increased risk of de novo malignancies, in some cases up to 15.6%. Data regarding pancreatic cancer following liver transplantation is limited. We aim to evaluate the incidence of pancreatic adenocarcinoma among liver transplant recipients in the United States. Describe survival in those patients and identify subgroup of patients at increased risk. METHODS: We examined the United Network of Organ Sharing (UNOS) database and identified patients with pancreatic adenocarcinoma who underwent liver transplant between 1988 and 2016. Patients 18 years of age and older were included. Demographics, primary diagnosis and survival data were recorded. Kaplan-Meier survival analyses and log-rank tests were performed. RESULTS: In the UNOS database, survival data regarding 142,488 patients was available and the cause of death was identified in 14,533 liver transplant recipients. A total of 140 patients developed pancreatic adenocarcinoma after liver transplantation. Most common indications for transplantations were Hepatitis C, alcohol cirrhosis and hepatocellular carcinoma (25 [17.9%], 24 [17.1%] and 9 [6.4%] respectively). Annual incidence was 16 pancreatic cancer cases per 100,000 transplant recipients. Compared to national annual incidence of 12.9 cancer cases per 100,000 patients, the relative risk was 1.23 (95% CI 0.59–2.56). Compared to other liver transplant recipients, those who developed pancreatic cancer were older and transplanted earlier in the time period evaluated ( P < 0.001 and P = 0.002 respectively). Gender, ethnicity, BMI, and primary diagnosis (i.e., transplant indication) were not significantly different among groups. Patient survival was significantly lower in patients who developed pancreatic adenocarcinoma (Log-rank test P < 0.001) (Figure 1). CONCLUSION: Analysis of the UNOS database showed that pancreatic adenocarcinoma is increased among liver transplant recipients without reaching statistical significance. Primary indications for transplantation and demographics were similar among both groups. Our findings suggest that pancreatic adenocarcinoma is more likely associated to long-standing immunosuppression and non-traditional risk factors rather than alcohol consumption or obesity. Further studies describing the natural history of pancreatic cancer after solid organ transplantation are suggested.

The need for liver transplantation (LT) among older patients is increasing, but the role of LT in the elderly (≥70 years) is not well defined. We retrospectively reviewed all primary LTs from 1998 through 2016 at our center. Survival and associated risk factors were analyzed with Cox regression and Kaplan‐Meier methods for LT recipients in 3 age groups: <60, 60‐69, and ≥70 years. Among 2281 LT recipients, the median age was 56 years (range, 15‐80 years), and 162 were aged ≥70 years. The estimated 5‐ and 10‐year patient survival probabilities for elderly LT recipients were lower (70.8% and 43.6%) than for recipients aged 60‐69 years (77.2% and 64.6%) and <60 years (80.7% and 67.6%). Patient and graft survival rates associated with LT improved over time from the pre–Model for End‐Stage Liver Disease era to Share 15, pre–Share 35, and Share 35 for the cohort overall (P < 0.001), but rates remained relatively stable in septuagenarians throughout the study periods (all P > 0.45). There was no incremental negative effect of age at LT among elderly patients aged 70‐75 years (log‐rank P = 0.32). Among elderly LT recipients, greater requirement for packed red blood cells and longer warm ischemia times were significantly associated with decreased survival (P < 0.05). Survival of LT recipients, regardless of age, markedly surpassed that of patients who were denied LT, but it was persistently 20%‐30% lower than the expected survival of the general US population (P < 0.001). With the aging of the population, select older patients with end‐stage liver diseases can benefit from LT, which largely restores their expected life spans.