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Over the past 2 decades, the rate of heart transplantation among patients with pretransplant malignancy (PTM) has increased dramatically. Although heart transplant recipients with a prior malignancy may be at an increased risk for early mortality, particularly those with a hematologic cancer, death rates after the first posttransplant year are comparable between patients with and without PTM. Results of an analysis of this patient population were published in the journal Circulation: Heart Failure.
A contemporary retrospective analysis of adults in the United Network for Organ Sharing registry was conducted among patients with PTM who had received heart transplantation between January 1, 2010, and December 31, 2020. Outcomes of interest in the study included mortality at 1 year following heart transplantation, mortality at 5 years for those who survived the first year after heart transplantation, and development of recurrent or de novo malignancy at 5 years post-heart transplantation. Among patients who developed more than 1 malignancy following heart transplantation, the date of the first occurrence was used in the analysis. The researchers examined patient characteristics, trends, and post-heart transplantation outcomes among the study population.
The percentage of patients with PTM who underwent heart transplantation increased significantly from 3.2% in 2000 to 8.2% in 2020 (P <.001). Additionally, the number of transplant centers that performed heart transplantations in patients with PTM more than doubled in the same time period, from 31.1% in 2000 to 71.3% in 2020 (P <.001). Among a total of 27,344 patients who underwent heart transplantation between 2010 and 2020, a history of PTM was reported in 7.7% of them.
PTM was associated with significantly higher rates of 1-year mortality following heart transplantation (11.9% vs 9.2% in those without PTM; adjusted hazard ratio [aHR], 1.25; 95% CI, 1.09-1.44; P =.001), which was driven by increased mortality in patients with hematologic PTM (aHR, 2.00; 95% CI, 1.61-2.48; P <.001). Among transplant recipients who survived the first year, 5-year survival was similar between those with and without PTM. At 5 years post-heart transplantation, rates of malignancy were higher in the PTM group than in patients without PTM (20.4% vs 13.1%, respectively; aHR, 1.57; 95% CI, 1.38-1.79; P <.001).
Overall, 89% of patients with PTM had a single malignancy prior to transplantation and 12% of them had 2 or more PTMs. Among individuals with PTM, 75% of them had a history of solid organ malignancy. The most common types of PTM were genitourinary/gynecologic/renal (in 28% of patients), hematologic (in 25% of patients), and breast (in 24% of patients). Patients with PTM, compared with those without PTM, were older (60 years vs 56 years, respectively); less likely to be male (56% vs 75%, respectively); and more likely to be White (71% vs 64%, respectively), on average, compared with those without PTM (P <.001 for all).
“Patients with prior hematologic malignancy may be at increased risk for early mortality,” the researchers wrote. “Guidelines which incorporate malignancy-specific characteristics and reflect current standards of oncological care are needed to inform management of this heterogeneous and expanding pool of patients.”
Disclosure: One of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.
Reference
Batra J, DeFilippis EM, Golob S, et al. Impact of pretransplant malignancy on heart transplantation outcomes: contemporary United Network for Organ Sharing analysis amidst evolving cancer therapies. Circ Heart Fail. Published online January 31. 2022. doi:10.1161/CIRCHEARTFAILURE.121.008968
