Risk of Hepatobiliary Cancer After Solid Organ Transplant in the United States

Clin Gastroenterol Hepatol. 2013 Dec 19. pii: S1542-3565(13)01964-2. doi: 10.1016/j.cgh.2013.12.018. [Epub ahead of print]

Koshiol J¹, Pawlish K², Goodman MT³, McGlynn KA⁴, Engels EA⁵.

Abstract

BACKGROUND & AIMS: Studies of liver cancer risk in recipients of solid organ transplants have generally been small, yielding mixed results, and little is known about biliary tract cancers among transplant recipients.

METHODS: We identified incident hepatobiliary cancers among 201,549 US recipients of solid organs, from 1987 through 2008, by linking data from the US transplant registry with 15 cancer registries. We calculated standardized incidence ratios (SIRs), comparing risk relative to the general population. We also calculated incidence rate ratios (RRs), comparing risk for hepatocellular carcinoma (HCC) and total (intrahepatic and extrahepatic) cholangiocarcinoma among subgroups of recipients.

RESULTS: Of transplant recipients, 165 developed hepatobiliary cancers (SIR, 1.2; 95% confidence interval [CI], 1.0-1.4). HCC risk was increased among liver recipients (SIR, 1.5; 95% CI, 1.0-2.2), especially 5 or more y after transplant (SIR, 1.8; 95% CI, 1.0-3.0). Cholangiocarcinoma was increased among liver (SIR, 2.9; 95% CI,1.6-4.8) and kidney recipients (SIR, 2.1; 95% CI, 1.3-3.1). HCC was associated with hepatitis B virus (RR, 3.2; 95% CI, 1.3-6.9), hepatitis C virus (RR, 10; 95% CI, 5.9-16.9), and non-insulin-dependent diabetes (RR, 2.5; 95% CI, 1.2-4.8). Cholangiocarcinoma was associated with azathioprine maintenance therapy (RR, 2.0; 95% CI, 1.1-3.7). Among liver recipients, primary sclerosing cholangitis (PSC) was associated with increased risk of cholangiocarcinoma, compared to the general population (SIR, 21; 95% CI, 8.2-42) and compared to liver recipients without PSC (RR, 12.3; 95% CI, 4.1-36.4).

CONCLUSIONS: Risks for liver and biliary tract cancer are increased among organ transplant recipients. Risk factors for these cancers include medical conditions and medications taken by recipients.

Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

KEYWORDS: BMI, CI, ECC, HBV, HCC, HCV, ICC, ICD-O-3, International Classification of Disease for Oncology, 3rd edition, PBC, PSC, RR, SIR, body mass index, confidence interval, epidemiology, extrahepatic cholangiocarcinoma, hepatitis B virus, hepatitis C virus, hepatocellular carcinoma, intrahepatic cholangiocarcinoma, liver disease, primary biliary cirrhosis, primary sclerosing cholangitis, rate ratio, standardized incidence ratio, transplantation

PMID: 24362053 [PubMed - as supplied by publisher]

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