Decreasing incidence of cancer after liver transplantation—A Nordic population‐based study over 3 decades

• Published in: American journal of transplantation Vol. 18; no. 4; pp. 952 - 963
• Main Authors: Nordin, A., Åberg, F., Pukkala, E., Pedersen, C. R., Storm, H. H., Rasmussen, A., Bennet, W., Olausson, M., Wilczek, H., Ericzon, B.‐G., Tretli, S., Line, P.‐D., Karlsen, T. H., Boberg, K. M., Isoniemi, H.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.04.2018
• Subjects: Adult; Cancer; cancer/malignancy/neoplasia: registry/incidence; cancer/malignancy/neoplasia: risk factors; Cholangitis; clinical research/practice; Cohort Studies; Colorectal carcinoma; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - etiology; Colorectal Neoplasms - prevention & control; Female; Follow-Up Studies; Health risk assessment; Humans; Immunosuppression; Incidence; Liver; Liver cancer; Liver diseases; Liver Neoplasms - epidemiology; Liver Neoplasms - etiology; Liver Neoplasms - prevention & control; Liver transplantation; Liver Transplantation - adverse effects; liver transplantation/hepatology; Liver transplants; Lung cancer; Lung Neoplasms - epidemiology; Lung Neoplasms - etiology; Lung Neoplasms - prevention & control; Lymphoma; Male; Medicin och hälsovetenskap; Middle Aged; Population studies; Population-based studies; Prognosis; Registries - statistics & numerical data; Risk Factors; Scandinavian and Nordic Countries - epidemiology; Skin cancer; Transplants & implants; Scandinavian and Nordic Countries; cancer/malignancy/neoplasia: registry/incidence; cancer/malignancy/neoplasia: risk factors; liver transplantation/hepatology; clinical research/practice
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/ajt.14507

Cancer remains one of the most serious long‐term complications after liver transplantation (LT). Data for all adult LT patients between 1982 and 2013 were extracted from the Nordic Liver Transplant Registry. Through linkage with respective national cancer‐registry data, we calculated standardized incidence ratios (SIRs) based on country, sex, calendar time, and age‐specific incidence rates. Altogether 461 cancers were observed in 424 individuals of the 4246 LT patients during a mean 6.6‐year follow‐up. The overall SIR was 2.22 (95% confidence interval [CI], 2.02‐2.43). SIRs were especially increased for colorectal cancer in recipients with primary sclerosing cholangitis (4.04) and for lung cancer in recipients with alcoholic liver disease (4.96). A decrease in the SIR for cancers occurring within 10 years post‐LT was observed from the 1980s: 4.53 (95%CI, 2.47‐7.60), the 1990s: 3.17 (95%CI, 2.70‐3.71), to the 2000s: 1.76 (95%CI, 1.51‐2.05). This was observed across age‐ and indication‐groups. The sequential decrease for the SIR of non‐Hodgkin lymphoma was 25.0‐12.9‐7.53, and for nonmelanoma skin cancer 80.0‐29.7‐10.4. Cancer risk after LT was found to be decreasing over time, especially for those cancers that are strongly associated with immunosuppression. Whether immunosuppression minimization contributed to this decrease merits further study. This multicenter study from four countries finds that overall cancer incidence after liver transplantation has decreased over time relative to the general population, especially for immunosuppression‐related cancer types.