Risk Factors for Malignancy after Orthotopic Heart Transplant: An Analysis of the UNOS Registry

Abstract

PurposeFor patients with end stage heart failure, orthotopic heart transplant (OHT) remains the definitive management. Advances in immunosuppression have led to improved long-term survival. Malignancy is an important cause of long-term morbidity and mortality with a reported rate of occurrence between 20-40% within 10 years of transplant. To date, significant evidence into mechanisms and risk profiles for post OHT malignancy is lacking. The purpose of this study is to identify patient and donor related factors associated with post OHT malignancy.MethodsWe performed a retrospective analysis of 51,218 OHT recipients captured in the United Network for Organ Sharing (UNOS) registry. Included in this analysis were adults 18 years and older who received a heart transplant between 1987 and 2019. The patients were categorized by the presence of post OHT malignancy (“yes”, “no”). Baseline characteristics were compared using chi-squared analysis for categorical variables and Mann-Whitney test for continuous variables. Logistic regressions were applied to evaluate the association between post OHT malignancy and the risk factors.ResultsWithin the study period (1987-2019), 13,060 OHT recipients (25.5%) developed a malignancy. Denovo solid tumors comprised 82% of all malignancy types. OHT recipients with malignancy were older (56 vs 50.9 years, p= <0.001), had higher proportion that were male (85% vs. 73%, p=<0.001), and White (90% vs. 68%, p= <0.001). Recipient factors associated with post OHT malignancy included older age (OR 1.05, CI 1.05-1.06, p= <0.001), White race (Asian OR 0.22, CI 0.16-0.30, p= <0.0001; Black OR 0.34, CI 0.30-0.38, p= 0.038; Hispanic OR 0.32, CI 0.27-0.39, p= 0.02), and treatment for rejection (OR 2.17, CI 1.04-4.52, p= 0.038).ConclusionIn this study, we reported the prevalence of post OHT malignancy as well as recipient and donor factors associated with post OHT malignancy. Further analysis based on malignancy subtype should be performed to aid in risk stratification and surveillance. For patients with end stage heart failure, orthotopic heart transplant (OHT) remains the definitive management. Advances in immunosuppression have led to improved long-term survival. Malignancy is an important cause of long-term morbidity and mortality with a reported rate of occurrence between 20-40% within 10 years of transplant. To date, significant evidence into mechanisms and risk profiles for post OHT malignancy is lacking. The purpose of this study is to identify patient and donor related factors associated with post OHT malignancy. We performed a retrospective analysis of 51,218 OHT recipients captured in the United Network for Organ Sharing (UNOS) registry. Included in this analysis were adults 18 years and older who received a heart transplant between 1987 and 2019. The patients were categorized by the presence of post OHT malignancy (“yes”, “no”). Baseline characteristics were compared using chi-squared analysis for categorical variables and Mann-Whitney test for continuous variables. Logistic regressions were applied to evaluate the association between post OHT malignancy and the risk factors. Within the study period (1987-2019), 13,060 OHT recipients (25.5%) developed a malignancy. Denovo solid tumors comprised 82% of all malignancy types. OHT recipients with malignancy were older (56 vs 50.9 years, p= <0.001), had higher proportion that were male (85% vs. 73%, p=<0.001), and White (90% vs. 68%, p= <0.001). Recipient factors associated with post OHT malignancy included older age (OR 1.05, CI 1.05-1.06, p= <0.001), White race (Asian OR 0.22, CI 0.16-0.30, p= <0.0001; Black OR 0.34, CI 0.30-0.38, p= 0.038; Hispanic OR 0.32, CI 0.27-0.39, p= 0.02), and treatment for rejection (OR 2.17, CI 1.04-4.52, p= 0.038). In this study, we reported the prevalence of post OHT malignancy as well as recipient and donor factors associated with post OHT malignancy. Further analysis based on malignancy subtype should be performed to aid in risk stratification and surveillance.