Malignancies before and after Heart Transplantation - A Single-Centre Long-Term Outcome Study

Abstract

PurposeHeart transplantation (HTx) has become the standard treatment for patients with end-stage heart disease. The aim of this study was to report our incidence and long-term outcome of malignancies after HTx.MethodsThe study is a single centre retrospective study of 664 patients, who underwent HTx at our centre between, 1985-2017. Data were retrieved from the Cancer Registry and the Birth and Death registry, both of which are obligatory national registries managed by the National Board of Health and Welfare.ResultsIn total, 231 malignancies were diagnosed in 138 patients (19.6%). The median follow-up time was 6.9 years (IQR 2.4-13.1). No patient was lost to follow-up. The overall risk of cancer following organ transplantation was 6.1-fold and 2.9-fold when excluding nonmelanoma skin cancer. The three most common malignancies were; nonmelanoma skin cancer, non-Hodgins lymphoma and lung cancer. There was no significant difference (p<0.79) in overall survival, 10 years after HTx, between those who had cancer before HTx and those who were cancer-free before HTx. Cumulative incidence for those who developed cancer post-transplant was analysed in a competing risk model showing cumulative incidence of cancer and mortality. There was no significant difference (p=0.22) in cumulative incidence of cancer as first event when transplantation was stratified into three time-eras (1985-2000, 2001-2010, 2011-2017). However, there was a significant difference in cumulative incidence of death as first event between those time-eras (p<0.001). Over time, survival has improved and despite that incidence of cancer have not increased.ConclusionNineteen percent of patients had experienced a malignancy after almost 7 years of median follow-up after HTx. We have shown an overall risk of cancer to be over 6-fold higher than among the general population, and almost 3-fold higher when non-melanoma skin cancer was excluded, after heart transplantation. Heart transplantation (HTx) has become the standard treatment for patients with end-stage heart disease. The aim of this study was to report our incidence and long-term outcome of malignancies after HTx. The study is a single centre retrospective study of 664 patients, who underwent HTx at our centre between, 1985-2017. Data were retrieved from the Cancer Registry and the Birth and Death registry, both of which are obligatory national registries managed by the National Board of Health and Welfare. In total, 231 malignancies were diagnosed in 138 patients (19.6%). The median follow-up time was 6.9 years (IQR 2.4-13.1). No patient was lost to follow-up. The overall risk of cancer following organ transplantation was 6.1-fold and 2.9-fold when excluding nonmelanoma skin cancer. The three most common malignancies were; nonmelanoma skin cancer, non-Hodgins lymphoma and lung cancer. There was no significant difference (p<0.79) in overall survival, 10 years after HTx, between those who had cancer before HTx and those who were cancer-free before HTx. Cumulative incidence for those who developed cancer post-transplant was analysed in a competing risk model showing cumulative incidence of cancer and mortality. There was no significant difference (p=0.22) in cumulative incidence of cancer as first event when transplantation was stratified into three time-eras (1985-2000, 2001-2010, 2011-2017). However, there was a significant difference in cumulative incidence of death as first event between those time-eras (p<0.001). Over time, survival has improved and despite that incidence of cancer have not increased. Nineteen percent of patients had experienced a malignancy after almost 7 years of median follow-up after HTx. We have shown an overall risk of cancer to be over 6-fold higher than among the general population, and almost 3-fold higher when non-melanoma skin cancer was excluded, after heart transplantation.