Jong-Chan Youn1, Josef Stehlik2, Amber R Wilk3, Wida Cherikh3, In-Cheol Kim4, Gyeong-Hun Park5, Lars H Lund6, Howard J Eisen7, Do Young Kim8, Sun Ki Lee8, Suk-Won Choi8, Seongwoo Han8, Kyu-Hyung Ryu8, Seok-Min Kang9, Jon A Kobashigawa10. 1. Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea. Electronic address: jong.chan.youn@gmail.com. 2. Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah. 3. United Network for Organ Sharing, Richmond, Virginia; ISHLT Transplant Registry, Dallas, Texas. 4. Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea. 5. Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea. 6. Department of Medicine, Unit of Cardiology, Karolinska Institutet, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden. 7. Division of Cardiology, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, Pennsylvania. 8. Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea. 9. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: smkang@yuhs.ac. 10. Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: kobashigawaj@cshs.org.
Abstract
BACKGROUND: Malignancy is a concern in cardiac transplant recipients, but the temporal trends of de novo malignancy development are unknown. OBJECTIVES: The goal of this study was to describe the temporal trends of the incidence, types, and predictors of de novo malignancy in cardiac transplant recipients. METHODS: The authors analyzed the temporal trends of post-transplant incidence, types, and predictors of malignancy using 17,587 primary adult heart-only transplant recipients from the International Society for Heart and Lung Transplantation registry. The main study outcomes included the incidence of, types of, and time to de novo malignancy. RESULTS: The risk of any de novo solid malignancy between years 1 and 5 after transplantation was 10.7%. The cumulative incidence by malignancy type was: skin cancer (7.0%), non-skin solid cancer (4.0%), and lymphoproliferative disorders (0.9%). There was no temporal difference in the time to development according to malignancy type. However, the cumulative incidence of de novo solid malignancy increased from 2000 to 2005 vs. 2006 to 2011 (10.0% vs. 12.4%; p < 0.0001). Survival in patients after de novo malignancy was markedly lower than in patients without malignancy (p < 0.0001). Older recipients and patients who underwent transplantation in the recent era had a higher risk of de novo malignancy. CONCLUSIONS: 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.
BACKGROUND:Malignancy is a concern in cardiac transplant recipients, but the temporal trends of de novo malignancy development are unknown. OBJECTIVES: The goal of this study was to describe the temporal trends of the incidence, types, and predictors of de novo malignancy in cardiac transplant recipients. METHODS: The authors analyzed the temporal trends of post-transplant incidence, types, and predictors of malignancy using 17,587 primary adult heart-only transplant recipients from the International Society for Heart and Lung Transplantation registry. The main study outcomes included the incidence of, types of, and time to de novo malignancy. RESULTS: The risk of any de novo solid malignancy between years 1 and 5 after transplantation was 10.7%. The cumulative incidence by malignancy type was: skin cancer (7.0%), non-skin solid cancer (4.0%), and lymphoproliferative disorders (0.9%). There was no temporal difference in the time to development according to malignancy type. However, the cumulative incidence of de novo solid malignancy increased from 2000 to 2005 vs. 2006 to 2011 (10.0% vs. 12.4%; p < 0.0001). Survival in patients after de novo malignancy was markedly lower than in patients without malignancy (p < 0.0001). Older recipients and patients who underwent transplantation in the recent era had a higher risk of de novo malignancy. CONCLUSIONS: 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.