Solid, non-skin, post-liver transplant tumors: Key role of lifestyle and immunosuppression management

Christophe Carenco (1, 2, 3) , Stéphanie Faure (2) , José Ursic-Bedoya (2) , Astrid Herrero (2, 4) , Georges Philippe Pageaux (2, 4)

1 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
2 Service Médico-Chirurgical des Maladies de l'Appareil Digestif et de Transplantation Hépatique
3 UM - Université de Montpellier
4 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)

Liver transplantation has been the treatment of choice for end-stage liver disease since 1983. Cancer has emerged as a major long-term cause of death for liver transplant recipients. Many retrospective studies that have explored standardized incidence ratio have reported increased rates of solid organ cancers post-liver transplantation; some have also studied risk factors. Liver transplantation results in a two to five-fold mean increase in the rate of solid organ cancers. Risk of head and neck, lung, esophageal, cervical cancers and Kaposi's sarcoma is high, but risk of colorectal cancer is not clearly demonstrated. There appears to be no excess risk of developing breast or prostate cancer. Environmental risk factors such as viral infection and tobacco consumption, and personal risk factors such as obesity play a key role, but recent data also implicate the role of calcineurin inhibitors, whose cumulative and dose-dependent effects on cell metabolism might play a direct role in oncogenesis. In this paper, we review the results of studies assessing the incidence of non-skin solid tumors in order to understand the mechanisms underlying solid cancers in post-liver transplant patients and, ultimately, discuss how to prevent these cancers. Immunosuppressive protocol changes, including a calcineurin inhibitor-free regimen, combined with dietary guidelines and smoking cessation, are theoretically the best preventive measures.

Mots clés: Calcineurin inhibitors; Immunosuppression; Incidence; Liver transplantation; Review; Risk factors; Tacrolimus; Tumors

Domaines: Hépatologie et Gastroentérologie; Cancer; Santé publique et épidémiologie; Immunothérapie

Christophe Carenco, Stéphanie Faure, José Ursic-Bedoya, Astrid Herrero, Georges Philippe Pageaux. Solid, non-skin, post-liver transplant tumors: Key role of lifestyle and immunosuppression management. World Journal of Gastroenterology, 2016, 22 (1), pp.427-34. ⟨10.3748/wjg.v22.i1.427⟩. ⟨hal-01881998⟩