De Novo Malignancy After Heart Transplantation

Study Questions:

What are the temporal trends of incidence, types, and predictors of de novo malignancy in cardiac transplant recipients?

Methods:

The study authors analyzed the temporal trends of post-transplant incidence, types, and predictors of malignancy using data from the International Society for Heart and Lung Transplantation registry. The cohort was comprised of 17,587 primary adult heart-only transplant recipients (age ≥18 years) from this registry. Study outcomes included the incidence of, types of, and time to de novo malignancy. The authors used a competing risks extension of the Kaplan-Meier method to estimate the rates of developing each type of malignancy between years 1 and 5 after transplantation.

Results:

The authors of the study reported that risk of any de novo solid malignancy between years 1 and 5 after transplantation was 10.7%. The leading malignancies were skin cancer (7.0%), nonskin solid cancer (4.0%), and lymphoproliferative disorders (0.9%). There was no temporal difference in the time to development by malignancy type. However, the cumulative incidence of de novo solid malignancy increased from 2000-2005 to 2006-2011 (10.0% vs. 12.4%, p < 0.0001). Survival in patients following de novo malignancy was markedly lower than in patients without malignancy (p < 0.0001). This increase was predominantly owing to the higher incidence of skin cancer in the more recent cohort (8.4% in 2006-2011 vs. 6.4% in 2000-2005, p < 0.0001). The cumulative incidence of nonskin solid cancer was also higher in the more recent era, but the degree of this increase was relatively small (4.5% in 2006-2011 vs. 4.0% in 2000-2005, p = 0.004). The incidence of lymphoproliferative disorders was not significantly different between the two cohorts (0.9% in 2006-2011 vs. 1.0% in 2000-2005, p = 0.1118). Within de novo skin cancer, the incidence of squamous carcinoma increased from 4.0% to 5.9%, and the incidence of basal cell carcinoma increased from 3.1% to 3.5%, both of which were statistically significant (p < 0.05). Within de novo nonskin solid cancer, the most frequent malignancies were prostate cancer (1.4% in 2006-2011 and 1.3% in 2000-2005) and lung cancer (1.0% in 2006-2011 and 1.1% in 2000-2005). Older recipients and patients transplanted in the recent era had a higher risk of de novo malignancy.

Conclusions:

The authors concluded that >10% of adult heart transplant recipients developed de novo malignancy between years 1 and 5 after transplantation, and this was associated with increased mortality.

Perspective:

As more and more older patients become recipients of orthotopic heart transplantation, the likelihood of malignancies is going to increase. As the study authors point out, immunosuppressive regimens may need to be re-evaluated to reduce the burden of de novo malignancies in this population.

Clinical Topics: Cardiac Surgery, Cardio-Oncology, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant

Keywords: Carcinoma, Basal Cell, Carcinoma, Squamous Cell, Cardiac Surgical Procedures, Cardiotoxicity, Geriatrics, Heart Failure, Heart Transplantation, Lung Neoplasms, Lymphoproliferative Disorders, Prostatic Neoplasms, Skin Neoplasms, Transplantation


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