S850 Esophageal Carcinoma Management Following Liver Transplant

Introduction: The purpose is to evaluate the management and outcomes of patients developing esophageal carcinoma following liver transplantation at a single transplant center. Methods: Retrospective evaluation of patients diagnosed with esophageal carcinoma following liver transplantation between 2004 and 2024. Data gathered including demographics, treatment, complications, and outcomes. Results: Eight patients were diagnosed with esophageal carcinoma following liver transplantation. Average age 66 years, 25% women; 3 were managed surgically and 5 managed medically. Reduction in immunosuppression occurred in 75% of patients. One hundred percent had reduction in calcineurin (7/7), 33% in prednisone (1/3), 66% in mycophenolate mofetil (2/3), 0% in everolimus (0/2), and 100% in azathioprine (1/1). No rejection following reduction of medication. Five had hepatocellular carcinoma, 3 nonalcoholic steatohepatitis, 1 hepatitis C, and 4 alcohol-associated liver disease. Post-transplant complications included graft-versus-host disease (1) and renal insufficiency and radial artery occlusion (1). Mean time between transplant and carcinoma diagnosis was 61 months (range 2-175 months). All were diagnosed via esophagogastroduodenoscopy performed for symptoms including dysphagia (5), odynophagia (2), anorexia (2), and weight loss (2). Two were asymptomatic at the time of diagnosis. Two had history of Barrett’s esophagus. Six had squamous cell carcinoma and 2 adenocarcinoma. Three were treated with endoscopic mucosal resection with resolution in all. Five were treated with chemoradiation of carboplatin-paclitaxel (2); folinic acid, fluorouracil, and oxaliplatin; and docetaxel-cisplatin and fluorouracil (1). Positron emission tomography/computed tomography and magnetic resonance imaging visualized metastasis to liver, vertebrae, pleura, and bone in 3 patients. Complications included cytopenia, radiation esophagitis, orthostatic lightheadedness and mucositis. Four out of 5 died from complications of cancer with 1 still on treatment. Five patients (1 surgical, 4 medical) died at a mean of 14.6 months post-diagnosis (range 9-26 months). Conclusion: Esophageal carcinoma is an aggressive malignancy with poor prognosis associated with immunosuppression use post-liver transplant. Balancing immunosuppression reduction and preventing transplant rejection can be difficult but the goal remains minimization of immunosuppression. Early vigilant screening in high-risk patients can reduce poor outcomes, allowing for surgical intervention of less advanced malignancy while avoiding adverse effects of chemoradiation.