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Impact of cyclosporine versus tacrolimus on the incidence of de novo malignancy following liver transplantation: a single center experience with 609 patients.
Transpl Int 2013; 26(10):999-1006TI

Abstract

De novo malignancies are a major cause of late death after liver transplantation. Aim of the present study was to determine whether use of cyclosporine versus tacrolimus affects long-term tumor incidence considering potential confounders. De novo malignancies in 609 liver transplant recipients at Munich Transplant Centre between 1985 and 2007 were registered. In 1996, the standard immunosuppressive regimen was changed from cyclosporine to tacrolimus. Different effects of those drugs on long-term tumor incidence were analyzed in multivariate analysis. During 3765 patient years of follow-up (median 4.78 years), 87 de novo malignancies occurred in 71 patients (mean age 47.5 ± 13.3 years, mean time after liver transplantation 5.7 ± 3.7 years). The cumulative incidence of de novo malignancies was 34.7% for all tumor entities after 15 years as compared to 8.9% for a nontransplanted population. The most frequent tumors observed were nonmelanoma skin cancers (44.83%). Moreover, post-transplant lymphoid disease, oropharyngeal cancer (n = 6, 6.9%), upper gastrointestinal tract cancer (n = 4, 4.6%), lung cancer (n = 4, 4.6%), gynecological malignancies (n = 4, 4.6%), and kidney cancer (n = 3, 3.45%) were detected. Multivariate analysis revealed recipient age [hazards ratio (HR) 1.06], male gender (HR 1.73), and tacrolimus-based immunosuppression (HR 2.06) as significant risk factors. Based on those results, a tacrolimus-based immunosuppression should be discussed especially in older male patients. Whether reducing tacrolimus target levels may reduce the risk for de novo malignancies has yet to be determined in prospective trials.

Authors+Show Affiliations

Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Munich, Germany.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23952102

Citation

Wimmer, Cosmas D., et al. "Impact of Cyclosporine Versus Tacrolimus On the Incidence of De Novo Malignancy Following Liver Transplantation: a Single Center Experience With 609 Patients." Transplant International : Official Journal of the European Society for Organ Transplantation, vol. 26, no. 10, 2013, pp. 999-1006.
Wimmer CD, Angele MK, Schwarz B, et al. Impact of cyclosporine versus tacrolimus on the incidence of de novo malignancy following liver transplantation: a single center experience with 609 patients. Transpl Int. 2013;26(10):999-1006.
Wimmer, C. D., Angele, M. K., Schwarz, B., Pratschke, S., Rentsch, M., Khandoga, A., ... Graeb, C. (2013). Impact of cyclosporine versus tacrolimus on the incidence of de novo malignancy following liver transplantation: a single center experience with 609 patients. Transplant International : Official Journal of the European Society for Organ Transplantation, 26(10), pp. 999-1006. doi:10.1111/tri.12165.
Wimmer CD, et al. Impact of Cyclosporine Versus Tacrolimus On the Incidence of De Novo Malignancy Following Liver Transplantation: a Single Center Experience With 609 Patients. Transpl Int. 2013;26(10):999-1006. PubMed PMID: 23952102.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of cyclosporine versus tacrolimus on the incidence of de novo malignancy following liver transplantation: a single center experience with 609 patients. AU - Wimmer,Cosmas D, AU - Angele,Martin K, AU - Schwarz,Bettina, AU - Pratschke,Sebastian, AU - Rentsch,Markus, AU - Khandoga,Andrej, AU - Guba,Markus, AU - Jauch,Karl-Walter, AU - Bruns,Christiane, AU - Graeb,Christian, Y1 - 2013/08/17/ PY - 2013/04/10/received PY - 2013/05/05/revised PY - 2013/07/21/accepted PY - 2013/8/20/entrez PY - 2013/8/21/pubmed PY - 2014/5/7/medline KW - calcineurin inhibitor KW - cancer development KW - immunosuppression KW - liver transplantation KW - long-term survival KW - multivariate analysis KW - risk factors SP - 999 EP - 1006 JF - Transplant international : official journal of the European Society for Organ Transplantation JO - Transpl. Int. VL - 26 IS - 10 N2 - De novo malignancies are a major cause of late death after liver transplantation. Aim of the present study was to determine whether use of cyclosporine versus tacrolimus affects long-term tumor incidence considering potential confounders. De novo malignancies in 609 liver transplant recipients at Munich Transplant Centre between 1985 and 2007 were registered. In 1996, the standard immunosuppressive regimen was changed from cyclosporine to tacrolimus. Different effects of those drugs on long-term tumor incidence were analyzed in multivariate analysis. During 3765 patient years of follow-up (median 4.78 years), 87 de novo malignancies occurred in 71 patients (mean age 47.5 ± 13.3 years, mean time after liver transplantation 5.7 ± 3.7 years). The cumulative incidence of de novo malignancies was 34.7% for all tumor entities after 15 years as compared to 8.9% for a nontransplanted population. The most frequent tumors observed were nonmelanoma skin cancers (44.83%). Moreover, post-transplant lymphoid disease, oropharyngeal cancer (n = 6, 6.9%), upper gastrointestinal tract cancer (n = 4, 4.6%), lung cancer (n = 4, 4.6%), gynecological malignancies (n = 4, 4.6%), and kidney cancer (n = 3, 3.45%) were detected. Multivariate analysis revealed recipient age [hazards ratio (HR) 1.06], male gender (HR 1.73), and tacrolimus-based immunosuppression (HR 2.06) as significant risk factors. Based on those results, a tacrolimus-based immunosuppression should be discussed especially in older male patients. Whether reducing tacrolimus target levels may reduce the risk for de novo malignancies has yet to be determined in prospective trials. SN - 1432-2277 UR - https://www.unboundmedicine.com/medline/citation/23952102/Impact_of_cyclosporine_versus_tacrolimus_on_the_incidence_of_de_novo_malignancy_following_liver_transplantation:_a_single_center_experience_with_609_patients_ L2 - https://doi.org/10.1111/tri.12165 DB - PRIME DP - Unbound Medicine ER -