Abstract
In liver transplant patients, solid tumors and post-transplant lymphoproliferative disorders (PTLD) have emerged as significant long-term mortality causes. Additionally, it is assumed that de novo malignancy (DNM) after liver transplantation (LT) is the second-leading cause of death after cardiovascular complications. Well-established risk factors for PTLD and solid tumors are calcineurin inhibitors (CNIs), tacrolimus (TAC), and cyclosporine, the cornerstones of all immunosuppressive (IS) therapies used after LT. The loss of immunocompetence facilitated by the host immune system due to prolonged IS therapy leads to cancer development, including in LT patients. Hindering DNA repair mechanisms, promoting tumor cell invasiveness, and hampering apoptosis are critical events in tumorigenesis and tumor growth in LT patients resulting from IS administration. This paper aims to overview the refined mechanisms of IS-induced tumorigenesis after LT and the loss of immunocompetence facilitated by the host immune system due to prolonged IS therapy. In addition, we also discuss in detail the mechanisms of action in different types of IS regimen used after LT, and their putative effect on DNM.
Highlights
Liver transplantation (LT) is the treatment of choice for patients with end-stage liver disease, such as decompensated liver disease, cirrhosis, acute hepatic failure, and hepatocellular cancer [1]
It was estimated that liver transplant recipients have a higher risk of developing de novo malignancy (DNM) compared to the general population, with standardized incidence ratios (SIRs) ranging from 2.3 to 4.3 [4,5]
Well-established risk factors for post-transplant lymphoproliferative disorders (PTLD) and solid tumors are calcineurin inhibitors (CNIs), tacrolimus (TAC), and cyclosporine, the cornerstones of all immunosuppressive therapies used after LT [7]
Summary
Liver transplantation (LT) is the treatment of choice for patients with end-stage liver disease, such as decompensated liver disease, cirrhosis, acute hepatic failure, and hepatocellular cancer [1]. In liver transplant patients, solid tumors and post-transplant lymphoproliferative disorders (PTLD) have emerged as significant long-term causes of death [3]. In 1981, cyclosporine was introduced in the post-LT period as a new immunosuppression (IS) drug This event was remarkable in the history of LT. The IS regimen improvement is one of the most critical factors leading to long-term survival and favorable outcome in patients after LT [8,9]. More prolonged patient survival after LT is correlated with prolonged exposure to IS Since such long-time therapy with IS is associated with unwanted adverse events, it is considered a double-edged sword [11]. To prevent adverse effects, especially those related to DNM, an optimal IS regimen plays a central role in long-term survival in patients after LT.
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