Author + information
- Received July 31, 2017
- Revision received October 23, 2017
- Accepted October 26, 2017
- Published online January 1, 2018.
- Jong-Chan Youn, MD, PhDa,∗ (, )
- Josef Stehlik, MD, MPHb,
- Amber R. Wilk, PhDc,d,
- Wida Cherikh, PhDc,d,
- In-Cheol Kim, MD, PhDe,
- Gyeong-Hun Park, MD, PhDf,
- Lars H. Lund, MD, PhDg,
- Howard J. Eisen, MDh,
- Do Young Kim, MDa,
- Sun Ki Lee, MD, PhDa,
- Suk-Won Choi, MD, PhDa,
- Seongwoo Han, MD, PhDa,
- Kyu-Hyung Ryu, MD, PhDa,
- Seok-Min Kang, MD, PhDi,∗∗ ( and )
- Jon A. Kobashigawa, MDj,∗∗∗ ()
- aDivision of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
- bDivision of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- cUnited Network for Organ Sharing, Richmond, Virginia
- dISHLT Transplant Registry, Dallas, Texas
- eDivision of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
- fDepartment of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
- gDepartment of Medicine, Unit of Cardiology, Karolinska Institutet, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
- hDivision of Cardiology, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, Pennsylvania
- iDivision of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- jDivision of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Jong-Chan Youn, Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Keunjaebong-gil 7, Hwaseong, Gyeonggi-do 18450, Republic of Korea.
- ↵∗∗Dr. Seok-Min Kang, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
- ↵∗∗∗Dr. Jon A. Kobashigawa, Division of Cardiology, Cedars-Sinai Heart Institute, 127 S. San Vicente Boulevard, Third Floor Cardiology, A3107, Los Angeles, California 90048.
Background Malignancy is a concern in cardiac transplant recipients, but the temporal trends of de novo malignancy development are unknown.
Objectives The goal of this study was to describe the temporal trends of the incidence, types, and predictors of de novo malignancy in cardiac transplant recipients.
Methods The authors analyzed the temporal trends of post-transplant incidence, types, and predictors of malignancy using 17,587 primary adult heart-only transplant recipients from the International Society for Heart and Lung Transplantation registry. The main study outcomes included the incidence of, types of, and time to de novo malignancy.
Results The risk of any de novo solid malignancy between years 1 and 5 after transplantation was 10.7%. The cumulative incidence by malignancy type was: skin cancer (7.0%), non-skin solid cancer (4.0%), and lymphoproliferative disorders (0.9%). There was no temporal difference in the time to development according to malignancy type. However, the cumulative incidence of de novo solid malignancy increased from 2000 to 2005 vs. 2006 to 2011 (10.0% vs. 12.4%; p < 0.0001). Survival in patients after de novo malignancy was markedly lower than in patients without malignancy (p < 0.0001). Older recipients and patients who underwent transplantation in the recent era had a higher risk of de novo malignancy.
Conclusions More than 10% of adult heart transplant recipients developed de novo malignancy between years 1 and 5 after transplantation, and this outcome was associated with increased mortality. The incidence of post-transplant de novo solid malignancy increased temporally, with the largest increase in skin cancer. Individualized immunosuppression strategies and enhanced cancer screening should be studied to determine whether they can reduce the adverse outcomes of post-transplantation malignancy.
This research was supported by the 2015 Transplant Registry Early Career Award Grant from the International Society for Heart and Lung Transplantation and by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT and Future Planning (NRF-2015R1C1A1A02036645). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Dr. Stehlik has served as a consultant to Medtronic. Dr. Kobashigawa has received a research grant from Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 31, 2017.
- Revision received October 23, 2017.
- Accepted October 26, 2017.
- 2018 American College of Cardiology Foundation
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