Cancer Incidence in Heart Transplant Recipients With Previous Neoplasia History

Abstract

Neoplasm history increases morbidity and mortality after solid organ transplantation and has disqualified patients from transplantation. Studies are needed to identify factors to be considered when deciding on the suitability of a patient with previous tumor for heart transplantation. A retrospective epidemiological study was conducted in heart transplant (HT) recipients (Spanish Post-Heart Transplant Tumor Registry) comparing the epidemiological data, immunosuppressive treatments and incidence of post-HT tumors between patients with previous malignant noncardiac tumor and with no previous tumor (NPT). The impact of previous tumor (PT) on overall survival (OS) was also assessed. A total of 4561 patients, 77 PT and 4484 NPT, were evaluated. The NPT group had a higher proportion of men than the PT group (p < 0.001). The incidence of post-HT tumors was 1.8 times greater in the PT group (95% confidence interval [CI] 1.2-2.6; p < 0.001), mainly due to the increased risk in patients with a previous hematologic tumor (rate ratio 2.3, 95% CI 1.3-4.0, p < 0.004). OS during the 10-year posttransplant period was significantly lower in the PT than the NPT group (p = 0.048) but similar when the analysis was conducted after a first post-HT tumor was diagnosed. In conclusion, a history of PT increases the incidence of post-HT tumors and should be taken into account when considering a patient for HT.

Management of Patients with Malignancy before Heart Transplantation

“…Other demographic and comorbid conditions were less important or not significant [10]. Another series could not identify PTM as predictor, even not after adjustment for gender and era, although male gender and era before 1993 were predictive [11]. In a pediatric series of patients with CCMP, listing in earlier era, need for a ventricular assist device and female gender were predictors for mortality after OHT, but CCMP was not [8].…”

“…However, the series investigating the effect of hematologic PTM on posttransplant outcome separately showed that this type of PTM resulted in a significantly worse post-transplant survival and this effect was larger than any demographic or comorbid factor, except for new onset dialysis [10]. Only in one series, patients with PTM had a decreased survival, but this became only evident after 5 years, and only in a univariate analysis [11].…”

“…In five manuscripts [3,5,8,10,11], a multiple regression analysis was performed. This showed the predictors for survival after OHT.…”

“…Serious comorbid conditions such as a PTM could limit post-transplant survival or prohibit an adequate immune suppression. For this reason, PTM was a relative contraindication to transplantation for a long time [10,11]. This view is shifting and this has its importance for young adult and pediatric patients considered for OHT who would have otherwise a long life expectancy because of improved cancer treatment [3][4][5]8].…”

“…Third, post-transplant malignancy is a consequence of immune suppression and remains a major cause of post-OHT, mortality [10,[12][13][14], especially with increasing duration of follow-up [15,16], without reaching a plateau [16]. The incidence of malignancy after OHT is high [11,12,14,17], compared to other organs transplants. In European series, this could reach 30% at about 9 year follow-up and could be responsible for more than 20% of the fatalities after OHT [12].…”