Smoking Linked to Cancer After Liver Transplantation
March 30, 2011 — Smoking predicted higher risk for malignancy after liver transplantation, and smoking withdrawal after transplant may protect against the development of neoplasia, according to the results of a study published online March 28 and in the April print issue of Liver Transplantation.
"Smoking is related to some of the most frequent causes of post-transplant malignancy," lead author J. Ignacio Herrero, MD, from the ClÃnica Universidad de Navarra in Pamplona, Spain, said in a news release. "We investigated whether the [risk] of developing malignancies was different in patients who ceased smoking than in patients who maintained smoking after transplantation."
The study authors note that risk for malignancy is increased in liver transplant recipients and that several of the most frequently experienced posttransplant cancers are head and neck, lung, esophageal, and kidney and urinary tract carcinomas, each of which is related to smoking. They studied the incidence and risk factors for the development of these cancers in 339 patients who received their first liver transplantation between April 1990 and December 2009 and who had a posttransplant survival longer than 3 months. Patients were treated with cyclosporine- or tacrolimus-based immunosuppression.
To assess whether smoking withdrawal was associated with a lower risk for malignancy, the researchers also studied risk factors for the development of smoking-related neoplasia in 135 patients who had a history of smoking. Factors studied were age, sex, alcohol abuse before liver transplantation, hepatitis C virus infection, hepatocellular carcinoma at transplantation, primary immunosuppression with cyclosporine vs tacrolimus, history of rejection requiring high doses of steroids or antilymphocytic globulins in the first 3 months, number of immunosuppressive drugs at 3 months, and smoking history.
After a mean follow-up of 7.5 years, 29 smoking-related malignancies were diagnosed in 26 patients, yielding 5- and 10-year actuarial rates of 5% and 13%, respectively. Factors independently associated with a higher risk for malignancy were smoking and older age, based on multivariate analysis. Among the subgroup of smokers, active smoking and older age were the variables associated with a higher risk for malignancy.
Although smoking in combination with immunosuppression was conventionally thought to be the main risk factor for transplant-related carcinomas, this study showed no association of longer duration of immunosuppressive treatment or stronger immunosuppression with higher risk for malignancy.
Limitations of this study include use of smoking as a categorical variable, precluding determination of a cumulative dosing effect; retrospective design; and low number of cancer events, which limited the multivariate analysis.
The investigators recommended confirming these findings in larger series or multicenter studies.
"Smoking withdrawal after liver transplantation may have a protective effect against the development of neoplasia," Dr. Herrero said. "As smoking is an important risk factor of malignancy, intervention programs, together with screening programs may help to reduce the rate of cancer-related mortality in liver transplant recipients."
The study authors have disclosed no relevant financial relationships.
Liver Transpl. Published online March 28, 2011. Abstract
March 30, 2011 — Smoking predicted higher risk for malignancy after liver transplantation, and smoking withdrawal after transplant may protect against the development of neoplasia, according to the results of a study published online March 28 and in the April print issue of Liver Transplantation.
"Smoking is related to some of the most frequent causes of post-transplant malignancy," lead author J. Ignacio Herrero, MD, from the ClÃnica Universidad de Navarra in Pamplona, Spain, said in a news release. "We investigated whether the [risk] of developing malignancies was different in patients who ceased smoking than in patients who maintained smoking after transplantation."
The study authors note that risk for malignancy is increased in liver transplant recipients and that several of the most frequently experienced posttransplant cancers are head and neck, lung, esophageal, and kidney and urinary tract carcinomas, each of which is related to smoking. They studied the incidence and risk factors for the development of these cancers in 339 patients who received their first liver transplantation between April 1990 and December 2009 and who had a posttransplant survival longer than 3 months. Patients were treated with cyclosporine- or tacrolimus-based immunosuppression.
To assess whether smoking withdrawal was associated with a lower risk for malignancy, the researchers also studied risk factors for the development of smoking-related neoplasia in 135 patients who had a history of smoking. Factors studied were age, sex, alcohol abuse before liver transplantation, hepatitis C virus infection, hepatocellular carcinoma at transplantation, primary immunosuppression with cyclosporine vs tacrolimus, history of rejection requiring high doses of steroids or antilymphocytic globulins in the first 3 months, number of immunosuppressive drugs at 3 months, and smoking history.
After a mean follow-up of 7.5 years, 29 smoking-related malignancies were diagnosed in 26 patients, yielding 5- and 10-year actuarial rates of 5% and 13%, respectively. Factors independently associated with a higher risk for malignancy were smoking and older age, based on multivariate analysis. Among the subgroup of smokers, active smoking and older age were the variables associated with a higher risk for malignancy.
Although smoking in combination with immunosuppression was conventionally thought to be the main risk factor for transplant-related carcinomas, this study showed no association of longer duration of immunosuppressive treatment or stronger immunosuppression with higher risk for malignancy.
Limitations of this study include use of smoking as a categorical variable, precluding determination of a cumulative dosing effect; retrospective design; and low number of cancer events, which limited the multivariate analysis.
The investigators recommended confirming these findings in larger series or multicenter studies.
"Smoking withdrawal after liver transplantation may have a protective effect against the development of neoplasia," Dr. Herrero said. "As smoking is an important risk factor of malignancy, intervention programs, together with screening programs may help to reduce the rate of cancer-related mortality in liver transplant recipients."
The study authors have disclosed no relevant financial relationships.
Liver Transpl. Published online March 28, 2011. Abstract
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