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Cancer after heart transplant common, confers mortality risk
One in 10 adult recipients of heart transplants developed new malignant cancer between 1 and 5 years after transplant, according to new findings.
Those who developed cancer had elevated mortality risk compared with those who did not, researchers reported.
Jong-Chan Youn, MD, PhD, from the division of cardiology at Dongtan Sacred Heart Hospital, Hallym University College of Medicine in Hwaseong, Korea, and colleagues analyzed 17,587 patients from the International Society for Heart and Lung Transplantation registry who received heart-only transplants as adults between 2000 and 2011.
Outcomes of interest included incidence of, types of and time to de novo malignancy. Patients were stratified by whether they received their transplant between 2000 and 2005 or between 2006 and 2011.
The risk for any de novo solid malignancy was 10.7% between 1 year and 5 years after transplantation, Youn and colleagues wrote.
Cumulative incidence by malignancy type was as follows: skin cancer, 7%; non-skin solid cancer, 4%; lymphoproliferative disorders, 0.9%; the malignancy types did not differ in time to development.
Cumulative incidence of de novo solid malignancy rose between 2000-2005 (10%) and 2006-2011 (12.4%; P < .0001), according to the researchers.
Patients with de novo malignancy had lower survival compared with patients who did not have cancer (P < .0001); this was consistent regardless of malignancy type, Youn and colleagues wrote.
Older age and transplant in 2006-2011 were predictors of risk for de novo malignancy (P < .0001 for both), the researchers found.
“Importantly, the increased risk of mortality was sizeable even for patients diagnosed with skin cancer; this finding is in contrast to the general population, in whom survival after skin cancer is typically favorable,” Youn and colleagues wrote. “Further research is necessary to investigate the best approaches for prevention and early detection of de novo malignancy.”
In a related editorial, Donna Mancini, MD, and Val Rakita, MD, both from the department of medicine at Mount Sinai Medical Center, wrote that the skin cancer findings “may not be accurate” because “the mortality directly attributed to skin cancer has been remarkably low. ... For the analysis to be better informed, the authors needed to be more selective in their control group. Clearly, the factors predisposing to skin cancer, such as increased age, smoking history, male sex and diabetes, are all associated with decreased survival, and without the advantage of having propensity matching of this cohort, the conclusions may be flawed.” – by Erik Swain
Disclosures: One author reports he is a consultant for Medtronic. Another author reports he has received a research grant from Novartis. The other authors, Mancini and Rakita report no relevant financial disclosures.