RT Journal Article
T1 Cumulative exposure to tacrolimus and incidence of cancer after liver transplantation.
A1 Rodriguez-Peralvarez, Manuel
A1 Colmenero, Jordi
A1 Gonzalez, Antonio
A1 Gastaca, Mikel
A1 Curell, Anna
A1 Caballero-Marcos, Aranzazu
A1 Sanchez-Martinez, Ana
A1 Di Maira, Tommaso
A1 Herrero, Jose Ignacio
A1 Almohalla, Carolina
A1 Lorente, Sara
A1 Cuadrado-Lavin, Antonio
A1 Pascual, Sonia
A1 Lopez-Garrido, Maria Angeles
A1 Gonzalez-Grande, Rocio
A1 Gomez-Orellana, Antonio
A1 Alejandre, Rafael
A1 Zamora-Olaya, Javier
A1 Bernal-Bellido, Carmen
K1 Hepatocellular carcinoma
K1 Immunosuppression
K1 Malignancy
K1 Neoplasm
K1 Tacrolimus
AB Cancer is the leading cause of death after liver transplantation (LT). This multicenter case-control nested study aimed to evaluate the effect of maintenance immunosuppression on post-LT malignancy. The eligible cohort included 2495 LT patients who received tacrolimus-based immunosuppression. After 13 922 person/years follow-up, 425 patients (19.7%) developed malignancy (cases) and were matched with 425 controls by propensity score based on age, gender, smoking habit, etiology of liver disease, and hepatocellular carcinoma (HCC) before LT. The independent predictors of post-LT malignancy were older age (HR = 1.06 [95% CI 1.05-1.07]; p < .001), male sex (HR = 1.50 [95% CI 1.14–1.99]), smoking habit (HR = 1.96 [95% CI 1.42–2.66]), and alcoholic liver disease (HR = 1.53 [95% CI 1.19–1.97]). In selected cases and controls (n = 850), the mmunosuppression protocol was similar (p = .51). An increased cumulative exposure to tacrolimus (CET), calculated by the area under curve of trough concentrations, was the only immunosuppression-related predictor of post-LT malignancy after controlling for clinical features and baseline HCC (CET at 3 months p = .001 and CET at 12 months p = .004). This effect was consistent for de novo malignancy (after excluding HCC recurrence) and for internal neoplasms (after excluding non-melanoma skin cancer). Therefore, tacrolimus minimization, as monitored by CET, is the key to modulate immunosuppression in order to prevent cancer after LT.
PB Elsevier
YR 2022
FD 2022-03-03
LK http://hdl.handle.net/10668/19890
UL http://hdl.handle.net/10668/19890
LA en
NO Rodríguez-Perálvarez M, Colmenero J, González A, Gastaca M, Curell A, Caballero-Marcos A, et al. Cumulative exposure to tacrolimus and incidence of cancer after liver transplantation. Am J Transplant. 2022 Jun;22(6):1671-1682
DS RISalud
RD Apr 10, 2025