A multi-institutional study of malignancies after heart transplantation and a comparison with the general United States population
Section snippets
Patient population
The CTRD database was established in 1990, and collection of malignancy data began in 1993. Between July 1, 1993, and December 31, 2008, 6,211 primary isolated adult heart transplants were performed at 35 centers participating in the CTRD. The median follow-up for 4,288 surviving patients was 5.45 years (range, 0–15.5 years). Methods of data collection, management, and event classification for the CTRD database have been previously described.12, 13, 14, 15, 16, 17
Immunosuppression
Immunosuppression protocols
Occurrence of malignancies over 15 years
Pre-transplant malignancies were documented in 283 of 6,211 primary heart transplants, but post-transplant recurrences of these pre-transplant malignancies were not common (Table 1). The 3 most common pre-transplant malignancies were lymphomas and cancers of the breast and prostate, which collectively constituted 46% of all pre-transplant malignancies.
There were 524 first primary post-transplant malignancies, excluding basal cell and squamous cell skin cancers (Table 2). Figure 1 depicts the
Discussion
Single-center and multi-institutional studies of long-term survival have shown that, among factors limiting long-term survival of cardiac transplant recipients, malignancy is a major contributor.1, 2, 3, 4, 5, 6, 7 In this study, we determined the incidence of malignancies among 6,211 patients at 35 institutions participating in the CTRD from July 1993 to December 31, 2008, a 15-year period. The data were compared with the normal U.S. population as determined by the SEER Cancer Statistics
Disclosure statement
None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.
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Cited by (34)
Canadian Cardiovascular Society/Canadian Cardiac Transplant Network Position Statement on Heart Transplantation: Patient Eligibility, Selection, and Post-Transplantation Care
2020, Canadian Journal of CardiologyCitation Excerpt :The 2018 ISHLT registry showed increasing trends in the cumulative incidence of de novo malignancies after HTx.153 Skin, post transplantation lymphoproliferative disorders (PTLD), and prostate and lung cancers are the most common causes of de novo malignancies after HTx.153,154 Risk factors associated with de novo malignancies include older age at the time of transplantation, male sex, and aggressive immunosuppressive therapy.
De novo malignancy in heart transplant recipients: A single center experience in Japan
2019, Journal of CardiologyCitation Excerpt :In the present study, the overall incidence of de novo malignancy after HTX was 6.8%, and PTLD (3/7; 43%), colon cancer (2/7; 29%), bladder cancer (1/7; 14%), and skin cancer (1/7; 14%) were observed. There were no patients with lung cancer, which had been reported to be common and associated with poor prognosis after HTx [10,11]. Additionally, the prevalence of PTLD, which was reported to be common in pediatric heart transplant recipients [12], and colon cancer were higher and that of skin cancer was lower compared to data from Western countries (PTLD, 7.7–17%; colon cancer, 2.4–8.6%; and skin cancer, 41.5–61%) [5,6,13,14].
Older and Wiser: Personalized Immunosuppression in the Current Era
2017, JACC: Heart FailureSurgical Treatment of Heart Failure
2017, Surgical Clinics of North AmericaCitation Excerpt :More than 405 of patients awaiting transplant are now transplanted as BTT recipients requiring LVAD explant (Fig. 16). Long-term cardiac transplant recipients experience increased risk for cutaneous malignancies and lymphoproliferative disease or lymphoma.47 Multivariable analysis showed older age and earlier transplant year were highly significant risk factors.
Heart Transplantation and Left Ventricular Assist Devices in Cancer Survivors
2017, Cardio-Oncology: Principles, Prevention and ManagementCancer After Heart Transplantation: A 25-year Single-center Perspective
2016, Transplantation ProceedingsCitation Excerpt :Immunosenescence begins early in childhood with the involution of the thymus, resulting in a declining output of naïve T cells and continues throughout life with age-dependent functional impairment of T cells. In elderly heart transplant patients, preexisting immunosenescence is likely exacerbated by immunosuppression, resulting in an incapacitated immune system, vulnerable to malignancy [21,22]. The other important risk factor in multivariate analysis was male recipient gender.