Calcineurin‐Inhibitor Discontinuation Could Reduce the Risk of De Novo Malignancies After Liver Transplantation for Alcohol‐Related Liver Disease
ABSTRACT Background De novo malignancies are one of the leading causes of death after liver transplantation (LT), particularly in patients transplanted for alcohol‐related liver disease (ALD). This retrospective study aimed to assess risk factors for malignancies and to evaluate the impact of calcin...
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| Veröffentlicht in: | Clinical transplantation 2024-10, Vol.38 (11), p.e70014-n/a |
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| creator | Erard, Domitille Steiner, Anouk Boillot, Olivier Thimonier, Elsa Vallin, Mélanie Veyre, Florian Guillaud, Olivier Radenne, Sylvie Dumortier, Jérôme |
| description | ABSTRACT
Background
De novo malignancies are one of the leading causes of death after liver transplantation (LT), particularly in patients transplanted for alcohol‐related liver disease (ALD). This retrospective study aimed to assess risk factors for malignancies and to evaluate the impact of calcineurin inhibitor (CNI) discontinuation.
Methods
From 1990 to 2015, all patients transplanted for ALD were included.
Results
A total of 493 patients were included, 77.9% were male and the median age at LT was 54 years. After LT, 278 de novo malignancies were diagnosed in 214 patients (43.4%). The cumulative incidence of de novo malignancies was 16.3% at 5 years, 34.4% at 10 years, and 49.8% at 15 years. In multivariate analysis, the independent risk factors were male gender (HR = 1.6), and active or weaned smoking (HR = 2.0). Discontinuation of CNI was a protective factor (HR = 0.6). Survival after diagnosis of de novo malignancy was 42.7% at 5 years and 27.5% at 10 years.
Conclusion
Our results confirm the major incidence of de novo malignancies after LT for ALD, as well as the important role of non‐modifiable risk factors such as smoking and gender. CNI discontinuation is a protective factor, and the only adaptable, and could be proposed in smoker male patients transplanted for ALD. |
| doi_str_mv | 10.1111/ctr.70014 |
| format | Article |
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Background
De novo malignancies are one of the leading causes of death after liver transplantation (LT), particularly in patients transplanted for alcohol‐related liver disease (ALD). This retrospective study aimed to assess risk factors for malignancies and to evaluate the impact of calcineurin inhibitor (CNI) discontinuation.
Methods
From 1990 to 2015, all patients transplanted for ALD were included.
Results
A total of 493 patients were included, 77.9% were male and the median age at LT was 54 years. After LT, 278 de novo malignancies were diagnosed in 214 patients (43.4%). The cumulative incidence of de novo malignancies was 16.3% at 5 years, 34.4% at 10 years, and 49.8% at 15 years. In multivariate analysis, the independent risk factors were male gender (HR = 1.6), and active or weaned smoking (HR = 2.0). Discontinuation of CNI was a protective factor (HR = 0.6). Survival after diagnosis of de novo malignancy was 42.7% at 5 years and 27.5% at 10 years.
Conclusion
Our results confirm the major incidence of de novo malignancies after LT for ALD, as well as the important role of non‐modifiable risk factors such as smoking and gender. CNI discontinuation is a protective factor, and the only adaptable, and could be proposed in smoker male patients transplanted for ALD.</description><identifier>ISSN: 0902-0063</identifier><identifier>ISSN: 1399-0012</identifier><identifier>EISSN: 1399-0012</identifier><identifier>DOI: 10.1111/ctr.70014</identifier><identifier>PMID: 39552184</identifier><language>eng</language><publisher>Denmark</publisher><subject>Adult ; Aged ; alcohol‐related liver disease ; calcineurin inhibitors ; Calcineurin Inhibitors - administration & dosage ; Calcineurin Inhibitors - therapeutic use ; de novo malignancies ; Female ; Follow-Up Studies ; Graft Rejection - etiology ; Graft Rejection - prevention & control ; Graft Survival - drug effects ; Humans ; Immunosuppressive Agents - therapeutic use ; Incidence ; Liver Diseases, Alcoholic - etiology ; Liver Diseases, Alcoholic - surgery ; liver transplantation ; Liver Transplantation - adverse effects ; Male ; Middle Aged ; Neoplasms - etiology ; Postoperative Complications - epidemiology ; Postoperative Complications - prevention & control ; Prognosis ; Retrospective Studies ; Risk Factors ; survival ; Survival Rate</subject><ispartof>Clinical transplantation, 2024-10, Vol.38 (11), p.e70014-n/a</ispartof><rights>2024 The Author(s). published by Wiley Periodicals LLC.</rights><rights>2024 The Author(s). Clinical Transplantation published by Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2504-f199eae7e6890e7b095b689c0fcb95ebf5d75455323560799a7dd8d5bad27d4e3</cites><orcidid>0000-0002-7824-5396 ; 0000-0002-5812-5696</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fctr.70014$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fctr.70014$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39552184$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Erard, Domitille</creatorcontrib><creatorcontrib>Steiner, Anouk</creatorcontrib><creatorcontrib>Boillot, Olivier</creatorcontrib><creatorcontrib>Thimonier, Elsa</creatorcontrib><creatorcontrib>Vallin, Mélanie</creatorcontrib><creatorcontrib>Veyre, Florian</creatorcontrib><creatorcontrib>Guillaud, Olivier</creatorcontrib><creatorcontrib>Radenne, Sylvie</creatorcontrib><creatorcontrib>Dumortier, Jérôme</creatorcontrib><title>Calcineurin‐Inhibitor Discontinuation Could Reduce the Risk of De Novo Malignancies After Liver Transplantation for Alcohol‐Related Liver Disease</title><title>Clinical transplantation</title><addtitle>Clin Transplant</addtitle><description>ABSTRACT
Background
De novo malignancies are one of the leading causes of death after liver transplantation (LT), particularly in patients transplanted for alcohol‐related liver disease (ALD). This retrospective study aimed to assess risk factors for malignancies and to evaluate the impact of calcineurin inhibitor (CNI) discontinuation.
Methods
From 1990 to 2015, all patients transplanted for ALD were included.
Results
A total of 493 patients were included, 77.9% were male and the median age at LT was 54 years. After LT, 278 de novo malignancies were diagnosed in 214 patients (43.4%). The cumulative incidence of de novo malignancies was 16.3% at 5 years, 34.4% at 10 years, and 49.8% at 15 years. In multivariate analysis, the independent risk factors were male gender (HR = 1.6), and active or weaned smoking (HR = 2.0). Discontinuation of CNI was a protective factor (HR = 0.6). Survival after diagnosis of de novo malignancy was 42.7% at 5 years and 27.5% at 10 years.
Conclusion
Our results confirm the major incidence of de novo malignancies after LT for ALD, as well as the important role of non‐modifiable risk factors such as smoking and gender. CNI discontinuation is a protective factor, and the only adaptable, and could be proposed in smoker male patients transplanted for ALD.</description><subject>Adult</subject><subject>Aged</subject><subject>alcohol‐related liver disease</subject><subject>calcineurin inhibitors</subject><subject>Calcineurin Inhibitors - administration & dosage</subject><subject>Calcineurin Inhibitors - therapeutic use</subject><subject>de novo malignancies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Graft Rejection - etiology</subject><subject>Graft Rejection - prevention & control</subject><subject>Graft Survival - drug effects</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Incidence</subject><subject>Liver Diseases, Alcoholic - etiology</subject><subject>Liver Diseases, Alcoholic - surgery</subject><subject>liver transplantation</subject><subject>Liver Transplantation - adverse effects</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasms - etiology</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>survival</subject><subject>Survival Rate</subject><issn>0902-0063</issn><issn>1399-0012</issn><issn>1399-0012</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kcFuGyEQhlHVqHbcHvICFcf24AR2l11ztNZtEslJJcs9r1iYjWkxOMC6yi2PkEteME8SknVzCwf4hT59MzAInVByStM6k9GfVoTQ4gMa05zzacrZRzQmnGQpl_kIHYfwJ92WtGSf0CjnjGV0VozRYy2M1BZ6r-3T_cOl3ehWR-fxQgfpbNS2F1E7i2vXG4VXoHoJOG4Ar3T4i12HF4Cv3d7hK2H0jRVWagh43kXweKn3aV97YcPOCBsHU5fscyPdxplUcQVGRFAHNlUFEeAzOuqECfDlcE7Q758_1vXFdPnr_LKeL6cyY6SYdpRzEFBBOeMEqpZw1qYoSSdbzqDtmKpYwVie5awkFeeiUmqmWCtUVqkC8gn6Nnh33t32EGKzTc8Gk5oF14cmpxkvZ5QWVUK_D6j0LgQPXbPzeiv8XUNJ8zKFJk2heZ1CYr8etH27BfVG_v_2BJwNwD9t4O59U1OvV4PyGW_8lYk</recordid><startdate>202410</startdate><enddate>202410</enddate><creator>Erard, Domitille</creator><creator>Steiner, Anouk</creator><creator>Boillot, Olivier</creator><creator>Thimonier, Elsa</creator><creator>Vallin, Mélanie</creator><creator>Veyre, Florian</creator><creator>Guillaud, Olivier</creator><creator>Radenne, Sylvie</creator><creator>Dumortier, Jérôme</creator><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7824-5396</orcidid><orcidid>https://orcid.org/0000-0002-5812-5696</orcidid></search><sort><creationdate>202410</creationdate><title>Calcineurin‐Inhibitor Discontinuation Could Reduce the Risk of De Novo Malignancies After Liver Transplantation for Alcohol‐Related Liver Disease</title><author>Erard, Domitille ; Steiner, Anouk ; Boillot, Olivier ; Thimonier, Elsa ; Vallin, Mélanie ; Veyre, Florian ; Guillaud, Olivier ; Radenne, Sylvie ; Dumortier, Jérôme</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2504-f199eae7e6890e7b095b689c0fcb95ebf5d75455323560799a7dd8d5bad27d4e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>alcohol‐related liver disease</topic><topic>calcineurin inhibitors</topic><topic>Calcineurin Inhibitors - administration & dosage</topic><topic>Calcineurin Inhibitors - therapeutic use</topic><topic>de novo malignancies</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Graft Rejection - etiology</topic><topic>Graft Rejection - prevention & control</topic><topic>Graft Survival - drug effects</topic><topic>Humans</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Incidence</topic><topic>Liver Diseases, Alcoholic - etiology</topic><topic>Liver Diseases, Alcoholic - surgery</topic><topic>liver transplantation</topic><topic>Liver Transplantation - adverse effects</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasms - etiology</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>survival</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Erard, Domitille</creatorcontrib><creatorcontrib>Steiner, Anouk</creatorcontrib><creatorcontrib>Boillot, Olivier</creatorcontrib><creatorcontrib>Thimonier, Elsa</creatorcontrib><creatorcontrib>Vallin, Mélanie</creatorcontrib><creatorcontrib>Veyre, Florian</creatorcontrib><creatorcontrib>Guillaud, Olivier</creatorcontrib><creatorcontrib>Radenne, Sylvie</creatorcontrib><creatorcontrib>Dumortier, Jérôme</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Erard, Domitille</au><au>Steiner, Anouk</au><au>Boillot, Olivier</au><au>Thimonier, Elsa</au><au>Vallin, Mélanie</au><au>Veyre, Florian</au><au>Guillaud, Olivier</au><au>Radenne, Sylvie</au><au>Dumortier, Jérôme</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Calcineurin‐Inhibitor Discontinuation Could Reduce the Risk of De Novo Malignancies After Liver Transplantation for Alcohol‐Related Liver Disease</atitle><jtitle>Clinical transplantation</jtitle><addtitle>Clin Transplant</addtitle><date>2024-10</date><risdate>2024</risdate><volume>38</volume><issue>11</issue><spage>e70014</spage><epage>n/a</epage><pages>e70014-n/a</pages><issn>0902-0063</issn><issn>1399-0012</issn><eissn>1399-0012</eissn><abstract>ABSTRACT
Background
De novo malignancies are one of the leading causes of death after liver transplantation (LT), particularly in patients transplanted for alcohol‐related liver disease (ALD). This retrospective study aimed to assess risk factors for malignancies and to evaluate the impact of calcineurin inhibitor (CNI) discontinuation.
Methods
From 1990 to 2015, all patients transplanted for ALD were included.
Results
A total of 493 patients were included, 77.9% were male and the median age at LT was 54 years. After LT, 278 de novo malignancies were diagnosed in 214 patients (43.4%). The cumulative incidence of de novo malignancies was 16.3% at 5 years, 34.4% at 10 years, and 49.8% at 15 years. In multivariate analysis, the independent risk factors were male gender (HR = 1.6), and active or weaned smoking (HR = 2.0). Discontinuation of CNI was a protective factor (HR = 0.6). Survival after diagnosis of de novo malignancy was 42.7% at 5 years and 27.5% at 10 years.
Conclusion
Our results confirm the major incidence of de novo malignancies after LT for ALD, as well as the important role of non‐modifiable risk factors such as smoking and gender. CNI discontinuation is a protective factor, and the only adaptable, and could be proposed in smoker male patients transplanted for ALD.</abstract><cop>Denmark</cop><pmid>39552184</pmid><doi>10.1111/ctr.70014</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-7824-5396</orcidid><orcidid>https://orcid.org/0000-0002-5812-5696</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged alcohol‐related liver disease calcineurin inhibitors Calcineurin Inhibitors - administration & dosage Calcineurin Inhibitors - therapeutic use de novo malignancies Female Follow-Up Studies Graft Rejection - etiology Graft Rejection - prevention & control Graft Survival - drug effects Humans Immunosuppressive Agents - therapeutic use Incidence Liver Diseases, Alcoholic - etiology Liver Diseases, Alcoholic - surgery liver transplantation Liver Transplantation - adverse effects Male Middle Aged Neoplasms - etiology Postoperative Complications - epidemiology Postoperative Complications - prevention & control Prognosis Retrospective Studies Risk Factors survival Survival Rate |
| title | Calcineurin‐Inhibitor Discontinuation Could Reduce the Risk of De Novo Malignancies After Liver Transplantation for Alcohol‐Related Liver Disease |
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