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

Malignancies After Heart Transplantation

Caroline Stenman  1 , Andreas Wallinder  1   2 , Erik Holmberg  3   4 , Kristjan Karason  1   5   6 , Jesper Magnusson  1   7   6 , Göran Dellgren  1   2   6
Affiliations

Malignancies After Heart Transplantation

Caroline Stenman et al. Transpl Int. .

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.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Etiology of heart failure as proportions of patients by diagnosis prior to heart transplantation. DCM = dilated cardiomyopathy, IHD = ischemic heart disease, CHD = congenital heart disease, HCM = hypertrophic cardiomyopathy.
FIGURE 2
FIGURE 2
Cumulative incidence of competing risks cancer (A) and death (B), and related to time-era after heart transplantation. Both outcomes cancer and death need to be assessed together since they are competing outcomes. Estimates and 95% confidence intervals are shown under the number of patients at risk.
FIGURE 3
FIGURE 3
Pretransplant malignancy overall survival compared to those without. Estimates and 95% confidence intervals are shown under the number of patients at risk.
FIGURE 4
FIGURE 4
Pretransplant malignancy relative survival compared to those without. Estimates and 95% confidence intervals are shown under the number of patients at risk.
See this image and copyright information in PMC

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