Long-term follow-up of hearttransplant recipients with pre-transplant malignancies

Abstract

A pre-existing malignancy has disqualified patients from solid organ transplantation because of concerns regarding recurrence. We reviewed pre-transplant characteristics and long-term results in patients who underwent heart transplantation with a pre-existing malignancy, because there has been no prior study of these patients in the long term. All 214 patients who underwent heart transplantation from July 1985 through June 2004 were studied retrospectively Thirteen of these patients had been treated for a malignancy before transplantation. Pre-transplant characteristics (age, sex, diabetes, and weight) and post-transplant outcomes (rejection, infection, and survival) were compared for the 2 groups. The patients with pre-existing malignancies were younger (47 vs 54 years, P=0.014), less heavy (73 vs 79 kg, P=0.017), and more likely to be female (54% vs 22%, P=0.010), compared with recipients without a pre-malignancy. Pulmonary vascular resistances, histories of tobacco use, and incidence of pre-transplant diabetes were not different between the 2 groups. The mean duration of follow-up for the 2 groups was similar (2,760 days for the pre-malignancy group vs 2,215 days for the non-pre-malignancy group, P=NS). Episodes of treated rejection and infection for the pre-malignancy group vs the non-pre-malignancy group were similar (1.8 episodes of rejection vs 1.6 episodes, P=NS); and (1. 7 episodes of infection vs 0.8 episodes, P=0.098). None of the pre-malignancy patients had recurrence of their original cancer, and long-term survival for the 2 groups was essentially identical (63% vs 62% at 10 years, P=NS). The dissemination of reports such as these may enable more patients with cured malignancies to benefit from transplantation.

Fig. 1 This graph shows that 10-year survival was very similar in the 2 groups: 63% for the non-PTM patients and 62% for the PTM patients (P =NS). PTM = pre-transplant malignancy