Influence of renal insufficiency pre-heart transplantation on malignancy risk post-heart transplantation

Recent reports demonstrated that patients with heart failure (HF) might have an increased risk to develop malignancies. This is also seen in patients with chronic kidney disease (CKD). Immunosuppression in heart transplantation (HT) recipients additionally increases the risk of malignancies. The aim of this study was to determine the relation between HF duration and CKD pre-HT and the risk of malignancy development post-HT.

We included all adult HT recipients transplanted between January 2000 and November 2017 in our centre. Patients were excluded if they died or were retransplanted within 3 months post-HT. Clinical characteristics were retrospectively collected. Sixty out of 250 patients (24%) developed a malignancy after a median of 66 months [interquartile range 33-108] post-HT. In multivariable Cox regression analysis, HF duration was not a risk factor for all malignancies or solid organ malignancies post-HT [hazard ratio (HR) 1.033 (0.974-1.096), P = 0.281 and HR 1.036 (0.958-1.120), P = 0.376, respectively]. Age [HR 1.051 (1.016-1.086), P = 0.004] and CKD pre-HT [HR 2.173 (1.236-3.822), P = 0.007] were independent risk factors for all malignancies. CKD pre-HT [HR 2.542 (1.142-5.661), P = 0.022] increased the risk for solid organ malignancies. Exclusion of patients with durable mechanical circulatory support in the analysis did not alter the significance of these risk factors.

Duration of HF pre-HT was not associated with malignancy risk post-HT. CKD was an independent risk factor for malignancies post-HT. More studies are needed to investigate this association.