Rapid development of esophageal squamous cell carcinoma after liver transplantation for alcohol-induced cirrhosis

Abstract

Liver transplant recipients have an increased risk of developing de novo malignancies. It is generally accepted that chronic alcohol abuse is a contributive factor in the pathogenesis of several malignancies, in particular, of oropharyngeal squamous cell carcinoma (SCC). Thus, patients with end-stage alcohol-induced cirrhosis could be at risk of esophageal SCC following orthotopic liver transplantation (OLT). From January 1986 to December 1997 a total of 313 patients underwent OLT for various indications. Of these patients, 72 had alcohol-related cirrhosis. Oropharyngeal and esophageal malignancies after OLT were not observed in non-alcoholic patients. In contrast, these malignancies were diagnosed in three male patients who underwent transplantation for alcohol-induced cirrhosis (incidence 4.2%). Furthermore, all patients had a history of tobacco abuse. The tumors were located in the tongue of one patient and in the esophagus of two patients. While SCC of the tongue became apparent 5 years after OLT, esophageal SCC was detected 8 and 16 months after transplantation. Shortly before transplantation, endoscopy of the esophagus had not revealed evidence of pre-malignant dysplastic lesions in any of these patients. Thus, esophageal SCC may develop rapidly in patients undergoing transplantation for alcohol-related cirrhosis with a history of tobacco abuse before liver transplantation, which warrants careful post-transplant screening of these patients.