Malignancy after heart transplantation: analysis of 24-year experience at a single center.

BACKGROUND

Malignancy is an important complication after heart transplantation. The incidence, spectrum, risk factors, and clinical impact of posttransplant malignancy were investigated in a cohort of patients with long-term follow-up at a single center.

METHODS

Data for 835 patients who underwent heart transplantation between 1979 and 2002 and survived beyond one month were retrospectively evaluated for posttransplant skin cancer, solid organ tumors, and lymphoma.

RESULTS

One hundred thirty-nine malignancies developed in 126 patients (15.1%). Skin cancer, solid organ tumors, and lymphoma represented 49%, 27%, and 24% of the malignancies, respectively. Mean patient age at transplantation for patients developing skin cancer, solid organ tumor, and lymphoma were 50 years, 51 years, and 46 years, respectively (p = 0.024). Risk factors for skin cancer were: age greater than 40 at transplantation, number of treated rejection episodes in the first year after transplantation, and smoking history. Variables associated with solid organ malignancy development were age and smoking history. There was no variable related to the development of posttransplant lymphoma. Median survival after diagnosis of skin cancer, solid organ tumor, and lymphoma were 5.0 years, 0.3 years, and 0.7 years, respectively (p < 0.001).

CONCLUSIONS

Posttransplant malignancies have different risk factors and variable clinical impact. Older age at transplantation, smoking history, and more episodes of treated rejection were related to increased incidence of nonlymphoid malignancy incidence after heart transplantation, whereas no variable was associated with lymphoid malignancy. Skin cancers have a benign course, while solid organ malignancies and lymphomas carry an unfavorable prognosis.