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Neoplastic disorders after pediatric heart transplantation
1Department of Pediatrics, Stanford University, CA 94305.
Circulation
|November 1, 1993
Summary
Pediatric heart transplant recipients face a serious risk of neoplastic disorders, particularly lymphoproliferative types. Reducing immunosuppression can lead to tumor regression in many cases.
Area of Science:
- Pediatric Cardiology
- Transplantation Immunology
- Oncology
Background:
- Pediatric heart transplant recipients require lifelong immunosuppression, increasing their risk for neoplastic disorders.
- This study investigated the incidence and clinical spectrum of cancers in pediatric heart transplant patients.
- Data was collected from 80 patients transplanted between 1974 and 1992.
Observation:
- Tumors occurred in 12.5% of patients during a mean follow-up of 50 months.
- Tumor incidence was significantly higher in the pre-cyclosporine era (44%) compared to the cyclosporine era (8.5%).
- Higher initial doses of cyclosporine and prednisone, along with more early rejection episodes, were associated with increased tumor risk.
Findings:
- Eight lymphoproliferative disorders, one hepatocellular carcinoma, and one squamous cell carcinoma were diagnosed.
- Epstein-Barr virus was detected in six cases of lymphoproliferative disorder.
- Treatment strategies included reducing immunosuppression, radiotherapy, and chemotherapy, with five deaths reported (two tumor-related).
Implications:
- Neoplastic disorders pose a significant long-term risk for pediatric heart transplant survivors.
- The incidence of tumors in the cyclosporine era is comparable to adult transplant recipients.
- Lymphoproliferative disorders are common and may regress with reduced immunosuppression, highlighting the importance of careful management.