Malignancy After Heart Transplantation: Incidence, Prognosis and Risk Factors

Abstract

The Spanish Post-Heart-Transplant Tumour Registry comprises data on neoplasia following heart transplantation (HT) for all Spanish HT patients (1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003). This retrospective analysis of 3393 patients investigated the incidence and prognosis of neoplasia, and the influence of antiviral prophylaxis. About 50% of post-HT neoplasias were cutaneous, and 10% lymphomas. The cumulative incidence of skin cancers and other nonlymphoma cancers increased with age at HT and with time post-HT (from respectively 5.2 and 8.9 per 1000 person-years in the first year to 14.8 and 12.6 after 10 years), and was greater among men than women. None of these trends held for lymphomas. Induction therapy other than with IL2R-blockers generally increased the risk of neoplasia except when acyclovir was administered prophylactically during the first 3 months post-HT; prophylactic acyclovir halved the risk of lymphoma, regardless of other therapies. Institution of MMF during the first 3 months post-HT reduced the incidence of skin cancer independently of the effects of sex, age group, pre-HT smoking, use of tacrolimus in the first 3 months, induction treatment and antiviral treatment. Five-year survival rates after first tumor diagnosis were 74% for skin cancer, 20% for lymphoma and 32% for other tumors.

Posttransplant Lymphoproliferative Disorders Following Kidney Transplantation

“…102 Of interest, prophylactic treatment with nucleoside analogues during three months following heart transplantation was associated with reduced PTLD risk in the Spanish registry. 135,136 This effect was also observed in a multicentric case-control study of kidney transplant recipients. The authors showed that antiviral prophylactic treatment was associated with a significant decrease in the risk of PTLD, especially in the first year posttransplant.…”

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“…However, these results were not sta tistically significant in the multivariate analysis. 16 In contrast, Chen and associates 6 linked tacrolimus with an increased risk of posttransplant malignancies.…”

“…The Spanish Post Heart-Transplant Tumor Registry data showed that mycophenolate mofetil is associated with a lower incidence of skin cancer. 16 Azathioprine Azathioprine has known potential cancerous effects. The average dose of azathioprine is associated with an increased risk for cancer occurrence.…”

“…The Spanish Post Heart-Transplant Tumor Registry data also showed that azathioprine increases the risk of cancers, particularly of skin. 16 …”

Is murine gammaherpesvirus-68 (MHV-68) a suitable immunotoxicological model for examining immunomodulatory drug-associated viral recrudescence?

“…However, some of the side-effects of immunosuppressive therapy may lead to an increased prevalence of neoplasia or post-transplant lymphoproliferative disorder (PTLD). PTLD can be a concern after hematopoietic stem cell or solid organ transplant (SOT) and can lead to a variety of lymphoid cancers (Crespo-Leiro et al, 2008;Knowles, 1999;Zafar et al, 2008). PTLD occurs in the presence of immunosuppression, and may be associated with re-activation of EBV or KSHV from latency (Rezk & Weiss, 2007;Schwartz, 2001;Zafar et al, 2008).…”