Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Department of Pharmacy, National Cerebral and Cardiovascular Center, Osaka, Japan.
J Cardiol. 2019 Mar;73(3):255-261. doi: 10.1016/j.jjcc.2018.11.011. Epub 2018 Dec 23.
Because of aggressive immunosuppression, heart transplant recipients have a high risk of de novo malignancy, which is a major cause of death and worse prognosis, regardless of the type. However, the impact of de novo malignancy on Japanese heart transplant recipients is unknown.
We analyzed 103 Japanese heart transplant recipients over 18-years-old at the time of transplantation between April 1999 and April 2017. Patient characteristics and prognosis were compared between heart transplant recipients with or without de novo malignancy after heart transplantation (HTx). Additionally, univariate and multivariate analyses for the risk factors of de novo malignancy after HTx were performed.
De novo malignancy developed in 7 patients (6.8%; post-transplant lymphoproliferative disorders, n=3; Bowen's disease, n=1; colon cancer, n=2; bladder cancer, n=1). Follow-up time and previous antibody mediated rejection (AMR)≥grade 1 were risk factors of de novo malignancy after HTx in multivariate analysis (OR: 1.19, 95% CI: 1.00-1.42, p=0.043; and OR: 10.7, 95% CI: 1.37-83.68, p=0.038, respectively). History of malignancy was a potential risk factor, albeit not significant (OR: 23.05, 95% CI: 0.99-534.53, p=0.071). The survival rates in patients with de novo malignancy was significantly lower than in those without de novo malignancy (3-year survival rate: 100% versus 67%, p=0.0025).
Long follow-up time and previous AMR≥grade 1 were risk factors of de novo malignancy after HTx. Japanese heart transplant recipients with de novo malignancy have worse prognosis; therefore, screening examinations are important for early diagnosis.
由于采用了积极的免疫抑制治疗，心脏移植受者罹患新生恶性肿瘤的风险较高，这是导致死亡和预后不良的主要原因，无论肿瘤类型如何。然而，新生恶性肿瘤对日本心脏移植受者的影响尚不清楚。
我们分析了 1999 年 4 月至 2017 年 4 月期间 103 例年龄超过 18 岁的日本心脏移植受者。比较心脏移植后发生（post-transplant lymphoproliferative disorders，PTLD）和未发生新生恶性肿瘤（de novo malignancy）的心脏移植受者的患者特征和预后。此外，还对心脏移植后发生新生恶性肿瘤的危险因素进行了单因素和多因素分析。
7 例（6.8%）患者发生新生恶性肿瘤（PTLD，n=3；Bowen 病，n=1；结肠癌，n=2；膀胱癌，n=1）。多因素分析显示，移植后随访时间和既往 1 级以上抗体介导排斥反应（antibody mediated rejection，AMR）是心脏移植后发生新生恶性肿瘤的危险因素（OR：1.19，95%CI：1.00-1.42，p=0.043；OR：10.7，95%CI：1.37-83.68，p=0.038）。恶性肿瘤病史是一个潜在的危险因素，但无统计学意义（OR：23.05，95%CI：0.99-534.53，p=0.071）。发生新生恶性肿瘤的患者生存率明显低于未发生新生恶性肿瘤的患者（3 年生存率：100%比 67%，p=0.0025）。
移植后随访时间长和既往 AMR≥1 级是心脏移植后发生新生恶性肿瘤的危险因素。发生新生恶性肿瘤的日本心脏移植受者预后较差，因此筛查检查对于早期诊断非常重要。
