Korean J Transplant.  2022 Nov;36(Supple 1):S298. 10.4285/ATW2022.F-4378.

Clinical outcomes and implications of pretransplant history of malignancy in heart transplant recipient

Affiliations
  • 1Department of Cardiology, Samsung Medical Center, Seoul, Korea
  • 2Department of Cardiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 3Department of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
  • 4Department of Biostatistics Collaboration Unit, Yonsei University, Seoul, Korea
  • 5Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

Abstract

Background
The number of patients with prior malignancy needing heart transplant (HTx) is increasing; however, detailed clinical characteristics and long-term clinical outcomes of these patients are largely unknown. We sought to evaluate long-term clini-cal outcomes of HTx patients with pretransplant history of malignancy (PTM).
Methods
This study is a single-center retrospective analysis to assess the characteristics and outcomes of HTx recipients with PTM. Among 1,062 HTx recipients (between 1997 and 2013), 73 patients had a history of PTM. We compared long-term HTx out-comes between patients with PTM (n=73) and those without PTM (n=989). We analyzed post-HTx outcome, recurrence of PTM and development of de novo malignancies. Post-HTx outcome included overall survival, 10-year survival, 10-year freedom from cardiac allograft vasculopathy (CAV), nonfatal major adverse cardiac events (NF-MACE), any treated rejection (ATR), acute cellular rejection (ACR), and antibody mediated rejection (AMR).
Results
Four most common PTMs were lymphoproliferative disorders (18.2%), prostate cancers (18.2%), nonmelanoma skin cancers (18.2%), and breast cancers (13.0%). Median time from PTM and HTx was 9.0 years. During a median follow up of 8.6 years after HTx, patients with PTM, compared to those without, showed significantly higher incidence of posttransplant malig- nancies (43.8% vs. 20.8%, P<0.001) including 9.6% of PTM recurrences (n=7). However, patients with PTM, compared to those without, showed comparable overall survival, 10-year survival, 10-year freedom from CAV, NF-MACE, ATR, ACR, and AMR. HTx recipients with PTM showed comparable long-term clinical outcome to those without PTM.
Conclusions
Even with pretransplant history of malignancy, carefully selected HTx recipients showed comparable clinical outcome with patients without PTM, despite higher incidence of posttransplant malignancy. A history of PTM should not disqualify patients from HTx listing, while further research is necessary for prevention and early detection of posttransplant malignancies in these patients.

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