To analyze the clinical characteristics, treatments, and prognosis of patients with de novo digestive system malignancy following orthotropic liver transplantation(OLT).

Clinicopathological data of 4 patients with de novo digestive system malignancy out of 416 patients who underwent OLT and received postoperative follow-up in the Third Affiliated Hospital of Sun Yat-sen University from August 2003 to December 2008 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. There were 3 males and 1 female with age ranging from 48 to 61 years old and the median age of 57 years old. Clinical data of patients' age when underwent liver transplantation, primary disease, medical history, the smoking and drinking history, family history of cancer, treatment and prognosis of de novo digestive system malignancy were collected and analyzed.

The morbidity of de novo digestive system malignancy after OLT was 1.0%(4/416). The 4 patients were diagnosed as esophageal carcinoma, gastric carcinoma, hepatosarcoma and colon cancer respectively. The male to female ratio was 3∶1. The median age of patients when receiving OLT was 53 years old. The primary disease were hepatitis B with liver cirrhosis(n=2) and hepatocellular carcinoma (HCC) (n=2). Two cases with HCC were combined with hepatitis B, including 1 case with alcoholic liver cirrhosis. One case had history of gastric ulcer and one of colon polyps. Two cases had history of smoking and 1 case had long-term secondhand smoke exposure. Two cases had long-term drinking history and 1 case had liver cancer family history. The median length from liver transplantation to the diagnosis of de novo malignant tumors was 34 months (range: 10-71 months). Three patients converted to sirolimus instead of tacrolimus and 1 patient continued treatment with half amount of tacrolimus. Only one case received resection but refused radiotherapy and chemotherapy. The other 3 cases received no surgery, radiotherapy or chemotherapy. The median time from the diagnosis of de novo malignant tumors to death was 5 months (range: 2-25 months). All of the 4 patients died of tumor progression and multiple organ failure.

The prognosis of patients with de novo malignancy after OLT is poor. Risk factors of de novo digestive system malignancy should be evaluated before OLT and should be prevented and monitored effectively.