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- W3163417608 abstract "Potential conflict of interest: Nothing to report. Thank you for your letter and the attention to important risk associations between smoking and immunosuppression with malignancy. As you rightly mention, the limitations of the United Network for Organ Sharing database preclude analyzing those factors in our study and others like it. Unfortunately, these types of large databases do not provide information on many possible cofounding factors including smoking status, prior surgical history including a prior colectomy, family history, and specifics regarding a patient’s history of malignancy prior to transplant (exceptions including HCC and cholangiocarcinoma). We agree with the authors that a history of tobacco use and other known risk factors for the development of cancer is critical to further understand the patient populations at higher risk of developing a de novo malignancy following liver transplantation. Prior research showing that smoking is associated specifically with the development of both colorectal cancer and pancreatic cancer also exists (in the nontransplant population). A large meta‐analysis clarifying the association of cigarette smoking and colorectal cancer found a pooled relative risk of 1.18 (95% CI, 1.11‐1.25) for colorectal cancer in ever‐smokers versus never‐smokers.(1) A large meta‐analysis examining the risk of cigarette smoking and pancreatic cancer found an even more robust association, with a pooled risk of 1.7 (95% CI, 1.61‐1.87) for current smokers and 1.2 (95% CI, 1.11‐1.29) for former smokers.(2) The risk of de novo posttransplant malignancy may not be specific to tacrolimus but more to the general immunosuppressed state, but more granular data are certainly needed.(3) Overall, we are hopeful that as we continue to identify a liver transplant population at higher risk of developing a de novo posttransplant malignancy, we will be able to reduce modifiable risk factors to improve posttransplant mortality." @default.
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- W3163417608 date "2021-08-21" @default.
- W3163417608 modified "2023-09-26" @default.
- W3163417608 title "REPLY:" @default.
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- W3163417608 doi "https://doi.org/10.1002/hep.31901" @default.
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