Outcomes of liver transplant recipients with pretransplant malignancies: Insights from a single institution’s experience.

Nikitha Vobugari University of Minnesota, Minneapolis, MN info_outline Nikitha Vobugari, Kirk Heyne, Ashton Connor, Zainub Ajmal, Shubham Adroja, Yuan Gao, Sunil Mathur, Sudha Kodali, Ashish Saharia, Constance M Mobley, Ahmed M Elaileh, Khush Patel, Rafik Mark Ghobrial

Authors Nikitha Vobugari University of Minnesota, Minneapolis, MN info_outline Nikitha Vobugari, Kirk Heyne, Ashton Connor, Zainub Ajmal, Shubham Adroja, Yuan Gao, Sunil Mathur, Sudha Kodali, Ashish Saharia, Constance M Mobley, Ahmed M Elaileh, Khush Patel, Rafik Mark Ghobrial Organizations University of Minnesota, Minneapolis, MN, Houston Methodist Cancer Center, Houston, TX, Houston Methodist Hospital, Houston, TX, Houston Methodist Neal Cancer Center, Houston, TX, Houston Methodist Neal Cancer Center, Missouri City, TX, Houston Methodist JC Walter Jr Center for Transplantation and Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston, TX, Houston Methodist Jr Center for Transplantation and Sherrie and Alan Conover Center for Liver Disease and Transplantation, Houston, TX, Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX Abstract Disclosures Research Funding No funding sources reported Background: Increasing liver transplantation (LT) utilization has resulted in more and more patients with a history of a non-hepatobiliary malignancy. Rather than deny such patients a lifesaving therapy the benefits must be weighed against risk of tumor recurrence and de novo malignancies (DNM) post-LT, especially with the immunosuppression required. While data has been presented on outcomes of pre transplant malignancies (PTM) in kidney and heart transplants, LT data is lacking. Our aim is to characterize rates of recurrence, DNM, and overall survival (OS) post-LT at a single, high volume American center. Methods: This retrospective study at Houston Methodist Hospital included patients who underwent LT with known history of PTM. Data was extracted from electronic health records, and descriptive statistics performed. Institutional IRB approval is obtained. Results: Between 01/1999- 12/2022, 1617 LTs were performed at our institute. We identified 261 LT recipients with 297 PTM, including 91 non- and 206 hepatobiliary cancers (See Table). Follow-up period ranged from 1 to 23 years. Post-LT malignancies were observed in 66 patients, 25% of the study population. Tumor recurrences accounted for 44 (17%) cases, and DNM were seen in 22 (8%). The DNMs included skin non-melanoma (n=8 cases), head & neck (3), PTLD (2), prostate (2), renal (1), lung (1), CRC (1), pancreatic (1), gynecologic (2), and poorly differentiated (1). The OS rate at 1-, 5-years (excluding those less than 5 years follow-up and unknown), and at time of last follow-up were 86.6%, 60-65% and 70%, respectively. Patients with post-LT malignancies had lower OS compared to those without (46% vs. 77.7%). Conclusions: To our knowledge, this study is the first to assess post-LT outcomes in patients with PTM. This study of LT recipients with PTM demonstrates post-LT malignancy rates of 25%, including 17% with recurrences and 8% with DNM. The latter is within the previously reported range of 3-14% DNM in the general post-LT population and dominated by skin cancers. Post-LT OS is excellent in these recipients and comparable to all LT patients. However, OS is lower in those with post-LT malignancies, implying a possible role for increased cancer surveillance. Limitations include retrospective design and potential chart bias. Future work in this cohort will focus on immunosuppression effects for this high-risk population. Composition of PTM and outcomes. PTM Number of LT Recipients Number of LT Recipients With Cancer Recurrence Number of LT Recipients Alive at Time of Data Collection/ 5years Hepatocellular carcinoma (HCC) 167 18 114 Cholangiocarcinoma (CCA) 39 14 20 Anal 1 0 1 Breast 19 3 15 Heme 9 0 9 Skin Melanoma 4 1 3 Skin Non-Melanoma 16 2 14 Renal 2 1 1 Prostate 5 1 4 Other/unknown GU 15 0 13 Colorectal (CRC) 11 2 8 Lung 2 1 2 Thyroid 4 0 4 Head and Neck (H&N) 2 0 1 CNS 1 1 1 Gynecologic 2 0 2 Total N of cancers 297 44 205 Total N of patients 261 42 196