Abstract 13819: Cancer After Heart Transplantation: Incidence, Risk Factors and Prognosis

Abstract

Introduction: Malignancy is a major cause of morbidity and mortality after heart transplantation. We determined incidence, risk factors and prognosis of cancer after heart transplantation in a large single center cohort with long-term follow-up. Methods: We retrospectively analyzed all patients undergoing heart transplantation at our institution between January 1987 and December 2013. Patients who died within the first month of transplantation were excluded. All remaining patients were followed up until death or December 2014 for development of cancer. Results: Five hundred and forty-one patients were followed up for a mean of 10.7 ± 6.7 years. Cancer was diagnosed in 181 patients, at a mean of 7.7 ± 5.0 years after transplantation. Cumulative incidence of any cancer at 1, 5 and 10 years was 2 %, 14 % and 29 %, respectively. Almost half of all cancers were skin tumors (83 patients), squamous-cell carcinoma (57 patients) being more frequent than basal-cell carcinoma (51 patients). The most frequent non-skin cancer was lung cancer (41 patients), followed by lymphoma (30 patients) and prostate cancer (25 patients). Several patients had more than one cancer. Age at transplantation older than 50 years (HR 3.3, p < 0.001), male gender (HR 2.1, p = 0.001), ischemic etiology for transplantation (HR 1.4, p = 0.02), transplantation era before 2000 (HR 1.4, p=0.04), azathioprine versus mycophenolate (HR 1.4, p= 0.04) and cyclosporine versus tacrolimus as initial immunosuppression (HR 1.7, p = 0.005) were significant risk factors for post-transplant malignancy in a univariate Cox proportional hazards model. Of these, age at transplantation and male gender were independent risk factors in multivariate analysis. Median patient survival after diagnosis of cancer was 2.9 years for patients with non-skin cancer, versus 13.1 years for patients with only skin cancer (p < 0.001). Conclusions: This study highlights the importance of cancer after heart transplantation. Older recipient age at transplantation and male gender were independent risk factors in multivariate analysis. Strategies to individualize immunosuppression according to the patient’s needs could potentially help reduce this important cause of morbidity and mortality after heart transplantation.