Incidence and risk factors for malignancy after heart transplantation- Analysis of the UNOS Registry

Malignancy threatens to limit survival in heart transplant recipients. Improved understanding of cancer risk is needed to direct prevention and screening strategies following heart transplantation. This study aims to describe the incidence, demographics, and risk factors associated with de novo malignancy, lymphoproliferative disorders, and solid-organ malignancy subtypes.

We analyzed the incidence, types, and predictors of malignancy in 50,370 heart transplant recipients from the United Network for Organ Sharing registry.

The incidence of de novo post-transplant malignancy at 10 years was 20.6%. The incidence at 10 years by malignancy type was: nonmelanoma skin cancer (9.0%), solid-organ cancer (6.2%), and lymphoproliferative disorder (1.2%). Older age (OR, 1.05; 95%CI, 1.049-1.060), male gender (female vs male; OR, 0.63; 95%CI, 0.58-0.68), induction immunosuppression with OKT3 (OR, 1.47; 95%CI, 1.23-1.76) or >1 induction agent (OR, 1.44; 95%CI, 1.14-1.82), history of cigarette use (OR, 1.19; 95%CI, 1.11-1.28) and hospitalization for infection (OR, 1.26; 95% CI, 1.18-1.34) were associated with increased incidence of de novo malignancy.

De novo malignancy is common, occurring in one-fifth of recipients after heart transplant. Risk factors for de novo malignancy included older age, male gender, induction immunosuppression, and history of cigarette use. Hospitalization for infection is a risk factor that has not been previously described. Improved prevention and personalized screening strategies are needed to reduce the adverse outcome of post-transplant malignancy.