Incidence of cancers following orthotopic liver transplantation in a single center: Comparison with national cancer incidence rates for England and Wales

Background. The incidence of de novo cancers is increased in liver allograft recipients but there are few data assessing the extent of the increased risk compared with a matched population. Methods. A retrospective study of 1,778 adults transplanted between January 1982 and March 2004, followed for a median of 65 months. The observed cancer incidence was compared with age-, sex-, and calendar year-matched expected cancer rates in England and Wales population. Results. In all, 141 (7.9%) developed a new cancer. There was an increase in the incidence of all tumors compared with that expected (Standardized Incidence Ratio (SIR) 207, 95% Cl 174-244, P<0.001); the greatest increase was seen in lymphoid tumors (SIR 1026, 95% Cl 608-1621, P<0.001), skin cancers (SIR 580, 95% Cl 432-763, P<0.001), and cancer of the large bowel (SIR 496, 95% Cl 290-774, P<0.001). Large bowel cancer was more common in those patients with ulcerative colitis than those without (SIR 2727 vs. 347) and in older patients. Females had a greater risk of lung cancer than males (SIR 336 vs. 56). Conclusions. There is an increased incidence of tumors following liver transplantation. Although the absolute risk of cancer is low, we found that the increase in risk is greater in the younger aged recipients than the older ones. Increased awareness of colon cancer is needed especially in older patients and those with ulcerative colitis. There should be awareness for the high lung cancer incidence in females. Increased surveillance for breast and cervical cancer is not necessary.