Malignancies After Heart Transplantation

Transpl Int. 2024 Sep 9:37:12109. doi: 10.3389/ti.2024.12109. eCollection 2024.

Abstract

Heart transplant patients have an increased risk of developing cancer. Patients who underwent HTx between 1985 and 2017 were included. Detection of cancer was obtained by cross-checking the study population with the Swedish Cancer-Registry and the Cause-of-Death-Registry. A total of 664 patients were followed for a median of 7.7 years. In all, 231 malignancies were diagnosed in 138 patients. Compared to the general population the excess risk of cancer following HTx was 6.2-fold calculated as the standardized incidence ratio (SIR) and 2.9-fold after exclusion of non-melanoma skin cancer (NMSC). The most common malignancies were NMSC, non-Hodgins lymphoma, and lung cancer. There was no significant difference in overall survival between those with and without a history of cancer before HTx (p = 0.53). During a median follow-up of 7.7 years, 19% of HTx recipients developed cancer, 6.2-fold higher relative to the general population, and 2.9-fold higher when excluding NMSC. Risk factors for malignancies (excluding NMSC) included previous smoking, hypertension and prolonged ischemic time; and for NMSC, increasing age, seronegative CMV-donors, and azathioprine. A previous cancer in selected recipients results in similar survival compared to those without cancer prior to HTx.

Keywords: cancer; cohort study; epidemiology; heart transplantation; single center study.

MeSH terms

  • Adult
  • Aged
  • Female
  • Heart Transplantation* / adverse effects
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Male
  • Middle Aged
  • Neoplasms* / epidemiology
  • Neoplasms* / etiology
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Registries
  • Risk Factors
  • Skin Neoplasms / epidemiology
  • Skin Neoplasms / etiology
  • Sweden / epidemiology

Substances

  • Immunosuppressive Agents

Grants and funding

The authors declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by grants from the Swedish Heart and Lung Foundation, and from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALFGBG-717811 to GD).