Temporal Trends of De Novo Malignancy Development After Heart Transplantation

Abstract

More than 10% of adult heart transplant recipients developed de novo malignancy between years 1 and 5 after transplantation, and this outcome was associated with increased mortality. The incidence of post-transplant de novo solid malignancy increased temporally, with the largest increase in skin cancer. Individualized immunosuppression strategies and enhanced cancer screening should be studied to determine whether they can reduce the adverse outcomes of post-transplantation malignancy.

De novo malignancy in heart transplant recipients: A single center experience in Japan

“…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]. These differences might be caused by differences in ethnicity, diet, environment, and viral status.…”

“…The etiology of malignancy involves impaired immunosurveillance; dysregulation of signaling pathways, DNA repair mechanisms, and apoptosis; and decreased anti-viral immune activity [16]. Age, male sex, smoking, and history of malignancy were reported as risk factors of de novo malignancy after HTx, similarly to the general population [5,6,11,[13][14][15]17]. CNI exhibits pro-carcinogenic potential by inhibition of DNA repair mechanisms and apoptosis [16].…”

“…Furthermore, everolimus inhibits increase in infected cells by EBV causing PTLD [18]. In terms of induction therapy, OKT3 was shown to increase the risk of de novo malignancy compared to basiliximab [5,13,16]. Subsequently, OKT3 use has discontinued and has been replaced by basiliximab [13].…”

“…reports investigating de novo malignancy after HTx in Western countries [5][6][7]. However, in the Japanese national survey on de novo malignancy after solid organ transplantation [8], most cases were kidney and hepatic transplant recipients (49.9% and 45.9%, respectively) and the proportion of heart transplant recipients was only 0.5%.…”

Cardiac transplantation: indications, eligibility and current outcomes

“…There is geographical variation in the incidence and type of malignancy following cardiac transplantation with a 10.7% risk of any de novo solid organ malignancy between 1 and 5 years post-transplant 50. Many of the common tumours are driven by viral infection including human papilloma virus (HPV), Epstein-Barr virus (EBV) and human herpes virus 8 (HHV8) 51–53.…”