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Cardiac transplantation in survivors of lymphoma: a multi-institutional survey
D O Taylor1, H H Farhoud, G Kfoury
1Department of Medicine, University of Utah Health Sciences Center, Salt Lake City Veterans Affairs Medical Center, LDS Hospital, USA.
Insights
Cardiac transplant recipients with a history of Hodgkin's disease (HD) and prior splenectomy face increased mortality risk. This study highlights splenectomy as an independent risk factor for poorer outcomes after heart transplantation in these patients.
Area of Science:
- Cardiology
- Oncology
- Transplantation Medicine
Background:
- Cardiac transplantation is viable in patients with prior Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL).
- Long-term outcomes and the impact of prior cancer and its treatment on cardiac transplant recipients remain understudied.
- Assessing recurrence risk and post-transplant health is crucial for these patients.
Purpose of the Study:
- To investigate the long-term influence of prior Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) on cardiac transplant outcomes.
- To identify risk factors affecting survival after heart transplantation in patients with a history of lymphoma.
- To evaluate the impact of cancer therapy and splenectomy on post-transplant results.
Main Methods:
- A survey was distributed to 130 US cardiac transplant centers via the United Network for Organ Sharing.
- Data collected included patient demographics, lymphoma type/stage/timing, prior cancer treatments, immunosuppression, rejection episodes, and outcomes.
- Epstein-Barr virus status was also recorded for analysis.
Main Results:
- Thirty-four cardiac transplant recipients with prior HD (n=16) or NHL (n=18) were analyzed.
- Actuarial survival rates at 1, 3, 5, 7, and 10 years were 77%, 64%, 64%, 64%, and 50%, respectively.
- Prior splenectomy was identified as an independent risk factor for mortality (adjusted relative risk 6.2; P=0.02), with lower survival in HD patients (P=0.04).
Conclusions:
- Cardiac transplant recipients with a history of Hodgkin's disease (HD) and prior splenectomy demonstrate an elevated mortality risk.
- Splenectomy emerges as a significant independent predictor of adverse outcomes following cardiac transplantation in this patient cohort.
- While numbers are small, findings underscore the importance of considering prior splenectomy in risk assessment for heart transplant candidates with a history of HD.
Background:
Cardiac transplantation has been successfully performed in patients with a history of presumably cured Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). Though the risk of recurrence is a major concern, the long-term influence of prior cancer and cancer therapy on posttransplant outcome has not been previously investigated.
Methods:
Questionnaires were sent to 130 cardiac transplant centers in the United States registered with the United Network for Organ Sharing. Data collected included patient demographics; type, stage, and timing of HD/NHL; treatment for HD/NHL; posttransplant immunosuppressive regimen, rejection history, and outcomes; and Epstein-Barr virus status.
Results:
Thirty-four cardiac transplant recipients with a previous history of HD (n=16) or NHL (n=18) were identified. HD patients averaged 41+/-15 years of age, with a mean disease-free interval of 15+/-9 years at the time of transplantation. NHL patients averaged 42+/-17 years of age with a mean disease-free interval of 10+/-9 years at the time of transplantation. The mean follow-up for the entire group was 50 months (range, 2 days to 136 months), and mean follow-up for the survivors was 67 months (range, 23-136 months). The 1-, 3-, 5-, 7-, and 10-year actuarial survival estimates for the entire group are 77%, 64%, 64%, 64%, and 50%, respectively. Actuarial survival was lower in HD patients (P=0.04) and in patients who had previously undergone splenectomy (P=0.008). Cox regression analysis identified only prior splenectomy (P=0.02) as an independent risk factor for mortality after cardiac transplantation with an adjusted relative risk of 6.2 (1.7-21.9, 95% confidence intervals).
Conclusions:
Although the numbers are small, these data strongly suggest that there is an increased mortality risk for cardiac transplant recipients with prior HD who have undergone splenectomy.