Malignancy Following Heart Transplant: Few and Far Between

Purpose De novo malignancy is a threat to long-term survival after heart transplantation (HTx) After five years, along with cardiac allograft vasculopathy (CAV), it is a leading cause of death. After ten years it is the primary cause of death, occurring among 25% of recipients. The objective of this study was to characterize risk factors for de novo malignancy after HTx. Methods Retrospective study in HTx recipients between 01/2008 and 05/2019 at a single institution. Patients who had a recorded malignancy pre-transplant were excluded, as well as subjects for whom pre-transplant malignancy status was unknown. Predictors of interest included use of induction immunosuppression, race, EBV serostatus and smoking history. The Kaplan-Meier method was used to estimate survival and competing risk methods were used to estimate the proportion of post-transplant lymphoproliferative disorder (PTLD) and solid organ tumor (SOT). Results The cohort consisted of 540 HTx recipients, predominantly male (74%) and Caucasian (54%). During the follow-up period, there were 5 cases of PTLD and 9 cases of de novo SOT. The 5-year survival [95% CI] was 77.4% [72.5%, 81.6%]. The cumulative proportion of PTLD at 5-year was 1.5% [0.2%, 2.8%] and the cumulative proportion of SOT was 1.5% [0.0%, 3.0%]. Stratified curves of the cumulative proportions of PTLD and SOT are presented for predictors of interest (induction, race, EBV status, smoking) in Figure 1. Race and use of induction therapy were not associated with development of PTLD or SOT. Among 447 patients with EBV+ serostatus, less than 2% developed PTLD. There were no cases of SOT among non-smokers but this predictor was not statistically significant (p=0.102). Conclusion In our HTx cohort, the cumulative 5-year proportion of PTLD and SOT were 1.5% and 3.5% respectively. There was no significant association of these malignancies with race, induction, EBV (for PTLD) and smoking status (for SOT), although analyses may have been limited by the small sample size. De novo malignancy is a threat to long-term survival after heart transplantation (HTx) After five years, along with cardiac allograft vasculopathy (CAV), it is a leading cause of death. After ten years it is the primary cause of death, occurring among 25% of recipients. The objective of this study was to characterize risk factors for de novo malignancy after HTx. Retrospective study in HTx recipients between 01/2008 and 05/2019 at a single institution. Patients who had a recorded malignancy pre-transplant were excluded, as well as subjects for whom pre-transplant malignancy status was unknown. Predictors of interest included use of induction immunosuppression, race, EBV serostatus and smoking history. The Kaplan-Meier method was used to estimate survival and competing risk methods were used to estimate the proportion of post-transplant lymphoproliferative disorder (PTLD) and solid organ tumor (SOT). The cohort consisted of 540 HTx recipients, predominantly male (74%) and Caucasian (54%). During the follow-up period, there were 5 cases of PTLD and 9 cases of de novo SOT. The 5-year survival [95% CI] was 77.4% [72.5%, 81.6%]. The cumulative proportion of PTLD at 5-year was 1.5% [0.2%, 2.8%] and the cumulative proportion of SOT was 1.5% [0.0%, 3.0%]. Stratified curves of the cumulative proportions of PTLD and SOT are presented for predictors of interest (induction, race, EBV status, smoking) in Figure 1. Race and use of induction therapy were not associated with development of PTLD or SOT. Among 447 patients with EBV+ serostatus, less than 2% developed PTLD. There were no cases of SOT among non-smokers but this predictor was not statistically significant (p=0.102). In our HTx cohort, the cumulative 5-year proportion of PTLD and SOT were 1.5% and 3.5% respectively. There was no significant association of these malignancies with race, induction, EBV (for PTLD) and smoking status (for SOT), although analyses may have been limited by the small sample size.