Liver transplantation in patients with history of extra-hepatic malignancies

INTRODUCTION: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSION: 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.