De Novo Malignancies after Heart Transplantation—A Single Center Experience

Background: Heart transplantation (htx) represents the gold standard in patients suffering from terminal heart failure. Malignancies are a common complication and important prognostic factor after htx. The aim of the study was to determine the incidence and risk factors for malignancies in patients after heart transplantation in our center.

Methods: 296 patients underwent htx in our center between 09/2010 and 08/2023. Perioperative parameters including morbidity and mortality as well as type of malignancy and the interval between htx and appearance of malignancy were analyzed. Patients were then divided into 3 groups: Group 1 suffered from skin cancer (n = 7), Group 2 from solid carcinoma (n = 17) and Group 3 had lymphoproliferative disorders (n = 2). Immunosuppression consisted of the usual triple combination (tacrolimus, mycophenolate mofetil and prednisolone). Whenever possible, mycophenolate mofetil was replaced with everolimus as early as possible after htx.

Results: The overall incidence of malignancy was 8.8% (26 of 296 patients), of these 26.9% had skin cancer (n = 7), 65.4% suffered from solid carcinoma (n = 17) and 7.7% from lymphoproliferative disorders (n = 2). After sepsis and graft failure malignancy represented the third leading cause of death with 13% of all deaths in our cohort. First diagnosis of the malignancy was on average 4.0 ± 2.7 years after htx. The preoperatively underlying cardiac disease did not significantly impact the incidence of malignancies. Out of all malignancies 23 occurred in male patients, 3 in female patients (88.5% vs. 11.5%, p < 0.05). Patients treated with the standard triple immunosuppression therapy displayed significant lower rates of malignancies, compared with the treatment with everolimus (42.3% vs. 57.7%, p = 0.021). Regarding pre- and perioperative complications, no significant differences could be found. Long-term survival was better in patients with skin-cancer compared with the other groups.

To date, 42.9% (n = 12) patients have died in consequence of their malignancy. Survival time after initial diagnosis was 8.4 ± 14.1 months.

Conclusion: In our patients the immunosuppression switch to everolimus at least did not reduce the incidence of malignancies after htx. Not unexpectedly patients with skin cancer displayed a better prognosis as diagnosis of this apparent tumor is normally easier. The overall incidence of de novo malignancies in our center is comparable to the literature. To further improve the prognosis of these malignancies early detection by close follow-up is essential, particularly to initiate a curative therapeutic approach.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
13 February 2024