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Cardiac transplantation in patients with preexisting neoplastic diseases
B S Edwards1, S A Hunt, M B Fowler
1Division of Cardiology, Stanford University School of Medicine, California.
Insights
Cardiac transplantation is now a viable option for select patients with a history of cancer. Previously, cancer disqualified patients, but this study shows comparable survival rates for heart transplant recipients with prior neoplastic disease.
Area of Science:
- Cardiology
- Oncology
- Transplantation Medicine
Background:
- Cardiac transplantation is typically for end-stage congestive heart failure (CHF) without systemic disorders.
- Patients with a history of malignancy have generally been excluded from cardiac transplant consideration.
- Neoplastic disease history was a contraindication for heart transplantation at most centers.
Observation:
- Eight cardiac transplants were performed in 7 patients with a history of neoplastic disease at Stanford University Medical Center over 4 years.
- Six patients had prior lymphoproliferative disorders; one had colon adenocarcinoma.
- Six of 7 patients were discharged, with a 1-year survival rate of 71%.
Findings:
- The 1-year post-transplant survival rate of 71% was comparable to the center's overall rate of 80%.
- Recurrent neoplasia occurred in 1 patient over a 2-year follow-up.
- Immunosuppression did not increase the risk of cancer recurrence or post-transplant lymphoproliferative disorders.
Implications:
- Carefully selected patients with a history of treated neoplastic disease may be eligible for cardiac transplantation.
- Prior malignancy should not be an absolute contraindication for heart transplant candidacy.
- This expands the pool of potential candidates for life-saving cardiac transplant procedures.
Abstract:
Cardiac transplantation has traditionally been reserved for individuals with end-stage congestive heart failure (CHF) in whom there is no history of other life-threatening systemic disorders. In most transplant centers, patients with a history of malignancy and severe heart failure have not been considered acceptable candidates for cardiac transplantation. In the last 4 years at Stanford University Medical Center, 8 cardiac transplants have been performed in 7 patients with a history of neoplastic disease. Six of these patients had already received treatment for lymphoproliferative disorders and in 1 case, a patient underwent a transplant after treatment for adenocarcinoma of the colon. Six of the 7 patients were discharged from the hospital and in that group, the 1-year posttransplant survival rate was 71%. This was comparable to an overall 1-year survival rate of 80% for patients undergoing a cardiac transplant at our center during the same period of time. At follow-up averaging over 2 years, there has been 1 case of recurrent neoplasia. One patient with evidence of radiation-induced pulmonary damage died of respiratory failure 2 days after transplantation. One patient required retransplantation because of intractable rejection and subsequently died from infectious complications. Immunosuppressive therapy in these patients has not been associated with an increased risk for neoplastic recurrence or for the development of posttransplant lymphoproliferative disorders. The current study demonstrates that in a carefully selected group, previously treated neoplastic disease should not represent a contraindication to cardiac transplantation.