AUTHOR=Vanlerberghe Benedict T. K. , van Malenstein Hannah , Sainz-Barriga Mauricio , Jochmans Ina , Cassiman David , Monbaliu Diethard , van der Merwe Schalk , Pirenne Jacques , Nevens Frederik , Verbeek Jef TITLE=Tacrolimus Drug Exposure Level and Smoking Are Modifiable Risk Factors for Early De Novo Malignancy After Liver Transplantation for Alcohol-Related Liver Disease JOURNAL=Transplant International VOLUME=37 YEAR=2024 URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2024.12055 DOI=10.3389/ti.2024.12055 ISSN=1432-2277 ABSTRACT=

De novo malignancy (DNM) is the primary cause of mortality after liver transplantation (LT) for alcohol-related liver disease (ALD). However, data on risk factors for DNM development after LT are limited, specifically in patients with ALD. Therefore, we retrospectively analyzed all patients transplanted for ALD at our center before October 2016. Patients with a post-LT follow-up of <12 months, DNM within 12 months after LT, patients not on tacrolimus in the 1st year post-LT, and unknown smoking habits were excluded. Tacrolimus drug exposure level (TDEL) was calculated by area under the curve of trough levels in the 1st year post-LT. 174 patients received tacrolimus of which 19 (10.9%) patients developed a DNM between 12 and 60 months post-LT. Multivariate cox regression analysis identified TDEL [HR: 1.710 (1.211–2.414); p = 0.002], age [1.158 (1.076–1.246); p < 0.001], number of pack years pre-LT [HR: 1.021 (1.004–1.038); p = 0.014] and active smoking at LT [HR: 3.056 (1.072–8.715); p = 0.037] as independent risk factors for DNM. Tacrolimus dose minimization in the 1st year after LT and smoking cessation before LT might lower DNM risk in patients transplanted for ALD.