*Purpose: De novo malignancy, frequent liver transplant (LT) complication, is one of the long-term major causes of mortality. Risk factors are related to immunosuppressive status, oncogenic virus activation, alcohol abuse. We want to investigate oncogenic action of alcohol after liver transplant in patients without post-transplant alcohol abuse.

*Methods: All liver recipients transplanted in our Centre from 1988 to 2018 were included. The latency period of neoplastic pathology onset, the type of tumor, the survival period and the treatment protocol carried out were analyzed.

*Results: We enrolled 593 patients undergone liver transplant. We found a de novo malignancy in 45 (8.7%) patients: 5 of hematological origin; 40 with a solid organ onset. In the former population, 35 (87.5%) were male and 5 (12.5%) were female; mean age was 53±9 years. Mean time between transplant and neoplastic diagnosis was 84±63 months. Cirrhosis etiology was alcoholic in 26(65%) patients (group 1) and non-alcoholic in 14(35%) patients (group 2). Population of two groups were homogeneous for pre- and post-transplant characteristics (age, sex, BMI, “Model for End Stage Disease” score, graft characteristic, immunosuppressive therapy). Latency time in neoplastic onset was early in group 1. Malignancies typologies encountered were: otolaryngologic; pulmonary; esophageal; gastric; renal; pancreatic; intestinal; mammary. There was a high prevalence of the neoplasm of the upper aerodigestive tract in group 1 (17vs5; p<0.05): Treatment: surgical (60%); medical (40%). The mean mortality from the diagnosis was, respectively, at 19 months in group 1 and 60 months in group 2 (p <0.05).

*Conclusions: Patients undergone LT for alcoholic cirrhosis have a higher risk of de novo malignancies, mainly in the upper aerodigestive tract. Early diagnosis and treatment result in improved prognosis and survival. Adequate management of immunosuppressive therapy and regular transplant and cancer screening are mandatory.

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