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Smoking in combination with immunosuppression poses greater risk for transplant-related carcinoma
Date:3/29/2011

urvival greater than three months. Participants received cyclosporine- or tacrolimus-based immunosuppression. Risk factors for the development of smoking-related neoplasia were also studied in 135 patients who had a history of smoking, in order to explore if smoking withdrawal was associated with a lower risk of malignancy.

SRM risk factors examined were age, sex, alcohol abuse before liver transplantation, hepatitis C virus infection, hepatocellular carcinoma at transplantation, primary immunosuppression (cyclosporine or 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. A second analysis of risk factors for the development of SRM was performed only in smokers, focusing on active versus prior smoking history.

After a mean follow-up of 7.5 years, 26 patients were diagnosed with 29 smoking-related malignancies. Five and ten-year actuarial rates were 5% and 13%, respectively. In multivariate analysis, smoking and a higher age were independently associated to a higher risk of malignancy. In the subgroup of smokers, the variables related to a higher risk of malignancy were active smoking and a higher age.

"Smoking withdrawal after liver transplantation may have a protective effect against the development of neoplasia," concluded Dr. Herrero. "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."


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