Long-term follow-up of lung and heart transplant recipients with pre-transplant malignancies

• Published in: The Journal of heart and lung transplantation Vol. 31; no. 12; pp. 1276 - 1280
• Main Authors: Sigurdardottir, Vilborg, MD, PhD, FEBTM, Bjortuft, Oystein, MD, PhD, Eiskjær, Hans, MD, PhD, Ekmehag, Bjorn, MD, PhD, Gude, Einar, MD, Gustafsson, Finn, MD, PhD, Hagerman, Inger, MD, PhD, Halme, Maija, MD, PhD, Lommi, Jyri, MD, PhD, Mared, Lena, MD, Riise, Gerdt C, MD, PhD, Simonsen, Svein, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2012; Elsevier
• Subjects: Adult; Biological and medical sciences; Cardiac and Cardiovascular Systems; Cardiology. Vascular system; Clinical Medicine; Disease-Free Survival; Female; Follow-Up Studies; Heart Transplantation; Humans; Kardiologi; Klinisk medicin; Lung Transplantation; Male; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Neoplasms - complications; Postoperative Complications; pre-transplant malignancy; Recurrence; Retrospective Studies; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; survival; Time Factors; recurrence; lung transplantation; heart transplantation; survival; pre-transplant malignancy; Heart; Graft(material); Lung; Malignancy; Transplantation; Malignant tumor; Homotransplantation; Long term; Phlebology; Treatment; Follow up study; Surgery; Graft; Circulatory system; Cardiology; Cancer
• DOI: 10.1016/j.healun.2012.09.007
• ISSN: 1053-2498; 1557-3117

Background Concern regarding recurrence of pre-transplant (Tx) malignancy has disqualified patients from Tx. Because this has been poorly studied in lung and heart Tx recipients our aim was to investigate the influence of pre-Tx malignancy on post-Tx recurrence and long-term survival, focusing on pre-operative cancer-free intervals. Methods From our lung and heart Tx programs (1983 to 2011) we retrospectively identified 111 (lung, 37; heart, 74) of 3,830 recipients with 113 pre-Tx malignancies. The patients were divided into 3 groups by pre-Tx cancer-free interval: Group I,<12 months ( n = 24); Group II,≥12 to<60 months ( n = 18); and Group III,≥60 months ( n = 71). Results Mean age at pre-Tx malignancy was 35±18 years. Mean post-Tx follow-up time was 70±63 months (range, 0–278 months), and malignancy recurrence was 63% in Group I, 26% in Group II, and 6% in Group III. Kaplan-Meier analysis of freedom from post-Tx recurrence revealed the following differences among the groups: Group I vs II, p = 0.08; II vs III, p = 0.002; and I vs III, p <0.001. Overall survival (51 deaths) was significantly poorer in Group I than in Groups II and III ( p = 0.044). Survival between Groups II and III did not differ significantly ( p = 0.93). Conclusions Cancer-free survival of≥5 years pre-Tx is associated with the lowest recurrence. However, recurrence is related to the time the patients were cancer-free, as seen in Groups I and II.