Heart transplantation in patients with previous malignancy. An overview

A history of malignancy has been considered as a contraindication for heart transplantation. The number of patients with prior malignancy needing transplantation is increasing due to improved survival and to cardiotoxic cancer treatment. However, this reluctance for transplantation can be challenged by the already available results.

A systematic literature search was performed in electronic databases. After exclusion of cardiac sarcomas, three case reports, thirteen series of which three are paediatric, two database searches and one article with specific design have been found. The larger series are of more recent origin. The study design of the manuscripts differed to some degree.

The preoperative profile and the postoperative results are reviewed. The preoperative profile includes demographics, interval between treatment of malignancy and transplantation, indication of transplantation and differences between patients with and without prior malignancy. An important observation is the increase of transplantation in patients with chemotherapy-related cardiomyopathy over time. The postoperative results.show that hospital mortality and long-term survival do not differ significantly between patients with and without pre-transplant malignancy. This seems also to be true for post-transplant recurrence.The disease-free pre-transplant interval has a major effect on both outcomes. Patients with haematologic malignancies and after splenectomy have a worse prognosis. Use of LVAD (left ventricular assist device) as bridge-to-transplant and rapamycin as immune suppression, holds some promises.

This review has some limitations since the published series are not comparable. It seems that transplantation in patients with prior malignancy can be justified in some cases, especially when the interval between malignancy and transplantation exceeds five years.