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...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 postliver 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.展开更多
Liver transplantation(LT)for alcohol-related liver disease(ALD)has come a long way since the implementation of LT as a standard procedure.Initially considered a contra-indication due to poor outcomes and moral issues(...Liver transplantation(LT)for alcohol-related liver disease(ALD)has come a long way since the implementation of LT as a standard procedure.Initially considered a contra-indication due to poor outcomes and moral issues(1,2),it is nowadays the most common indication for LT in Western countries(3,4).Patient and graft survival in this setting are excellent(5).However,relapse rates remain high(6),which jeopardizes long-term survival and the acceptance of the transplant team for these procedures.The evaluation of the suitability to a LT for a potential candidate is therefore essential.The length of sobriety,namely over six months,has longtime been considered as the condition sine qua non.The“6-month rule”is insufficient to predict the risk of relapse and is progressively being abandoned by learned societies recommendations(7,8).Moreover,situations in which a recent alcohol consumption is obvious,such as alcoholic hepatitis or positive blood and/or urine test before the procedure,are associated with good outcomes(9-11).展开更多
Chronic hepatitis B(CHB)affects approximately 257 million individuals worldwide,the highest prevalence being in Western Pacific WHO Region[6.2%(1)].In highly endemic CHB regions,the 5-year cumulative incidence of hepa...Chronic hepatitis B(CHB)affects approximately 257 million individuals worldwide,the highest prevalence being in Western Pacific WHO Region[6.2%(1)].In highly endemic CHB regions,the 5-year cumulative incidence of hepatocellular carcinoma(HCC)ranges from 3%to 17%,depending on the presence of cirrhosis(2).Antiviral treatment decreases the risk of HCC,without abolishing it completely(3).Paradoxically,by decreasing liver-related mortality,antiviral treatment in CHB patients causes an increase in HCC long-term incidence(4).展开更多
文摘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 postliver 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.
文摘Liver transplantation(LT)for alcohol-related liver disease(ALD)has come a long way since the implementation of LT as a standard procedure.Initially considered a contra-indication due to poor outcomes and moral issues(1,2),it is nowadays the most common indication for LT in Western countries(3,4).Patient and graft survival in this setting are excellent(5).However,relapse rates remain high(6),which jeopardizes long-term survival and the acceptance of the transplant team for these procedures.The evaluation of the suitability to a LT for a potential candidate is therefore essential.The length of sobriety,namely over six months,has longtime been considered as the condition sine qua non.The“6-month rule”is insufficient to predict the risk of relapse and is progressively being abandoned by learned societies recommendations(7,8).Moreover,situations in which a recent alcohol consumption is obvious,such as alcoholic hepatitis or positive blood and/or urine test before the procedure,are associated with good outcomes(9-11).
文摘Chronic hepatitis B(CHB)affects approximately 257 million individuals worldwide,the highest prevalence being in Western Pacific WHO Region[6.2%(1)].In highly endemic CHB regions,the 5-year cumulative incidence of hepatocellular carcinoma(HCC)ranges from 3%to 17%,depending on the presence of cirrhosis(2).Antiviral treatment decreases the risk of HCC,without abolishing it completely(3).Paradoxically,by decreasing liver-related mortality,antiviral treatment in CHB patients causes an increase in HCC long-term incidence(4).
