Liver transplantation in patients with history of extra-hepatic malignancies

TL;DR

This study examines liver transplant outcomes in patients with a history of extra-hepatic cancer, finding no significant difference in survival but noting that cancer recurrence after transplant is linked to worse outcomes.

Contribution

The study provides novel data on liver transplantation in patients with pre-transplant extra-hepatic malignancies, addressing a gap in existing literature.

Findings

Patients with a history of extra-hepatic malignancies had similar post-transplant survival compared to those without.

Cancer recurrence after liver transplant was strongly associated with worse survival outcomes.

A short interval (less than 2 years) between cancer diagnosis and transplant did not affect survival.

Abstract

Increasing use of solid organ transplantation [SOT] has coincided with increasing cancer survivorship. Consensus statements exist for SOT in patients with pre-transplant malignancy [PTM]. Yet, most outcomes have been reported in heart and kidney transplant. This paper addresses the shortage of information on liver transplant [LT] in patients with PTM.

A retrospective case-control study was conducted of patients who underwent LT between 1/1/2008–5/31/2024 at an American transplant center. Patients were stratified according to history of extrahepatic PTM, time from PTM to LT, and post-LT PTM recurrence. Primary outcomes were overall survival [OS] and time to recurrence.

1,876 patients underwent LT. 143(7.62%) had an extrahepatic PTM pre-LT. PTM patients were older and had lower MELD at LT. There was no significant difference in post-LT survival (p = 0.293) between patients who did and did not have PTM. Of 121 patients with known time from PTM to LT, 19(15.7%) had an interval less than 2 years. When stratifying by 2-year interval from PTM to LT, there was no difference in survival (p = 0.34). Post-LT, 20 patients (14.0%) had recurrence of their PTM. The average time to recurrence was 595.5 days. When treated as a time-dependent co-variate, recurrence was a strong predictor of worse post-LT survival (HR 10.9, 95% CI 4.32–27.7, p < 0.001).

In our experience, a history of pre-LT PTM, including with an interval to LT of less than 2 years, was not associated with worse post-LT survival. Recurrence of PTM did portend worse prognosis.

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