De novo malignancy in heart transplant recipients: A single center experience in Japan

Abstract

Heart transplantation (HTx) is an established and effective treatment for advanced heart failure [1]. The long-term prognosis after HTx has continuously improved as a consequence of reduced early post-transplant mortality [2]. In Japan, the survival rates at 5, 10, and 15 years after HTx are 92.7%, 89.6%, and 81.8%, better than those in Europe and the USA [3]. However, the incidence of de novo malignancy increases in the late period and is one of the major causes of death after HTx [4]. Malignancy negatively impacts the prognosis after HTx, regardless of the type of malignancy [5]. The risk of de novo malignancy in heart transplant recipients was reported to be 2-4 times higher than that in the general population [5-7]. Additionally, heart transplant recipients have a 4 times higher risk compared to renal transplant recipients due to their intensive immunosuppression therapy [5,6]. There are several

De <i>Novo</i> Papillary Urothelial Carcinoma at a Previous Ureteroneocystostomy Site for Benign Ureteral Injury

“…Some de novo malignancies following surgery have been reported. Kimura et al 6 reported an increase in the overall incidence of de novo malignancies after heart transplantation.…”

Management of Patients with Malignancy before Heart Transplantation

“…In the series focusing on the post-transplant malignancy, PTM had no significant effect, although the hazard ratio was just over 1.5 [16]. Some series had very low numbers [1,9,14]. Therefore, the results of small series warrant caution.…”

“…One series showed that hazard ratio of PTM on post-transplant malignancy was 1.5, but this was not significant [16]. Another series showed a significant difference in this respect (1/96 v. 1/14) but the absolute numbers were very low and other factors such as the type of induction treatment should be accounted for [14]. Interestingly, one series showed that skin cancer was by far the most common post-transplant malignancy, followed by lung cancer, prostate cancer and PTLD.…”

“…This view is shifting and this has its importance for young adult and pediatric patients considered for OHT who would have otherwise a long life expectancy because of improved cancer treatment [3][4][5]8]. Third, post-transplant malignancy is a consequence of immune suppression and remains a major cause of post-OHT, mortality [10,[12][13][14], especially with increasing duration of follow-up [15,16], without reaching a plateau [16]. The incidence of malignancy after OHT is high [11,12,14,17], compared to other organs transplants.…”

“…Third, post-transplant malignancy is a consequence of immune suppression and remains a major cause of post-OHT, mortality [10,[12][13][14], especially with increasing duration of follow-up [15,16], without reaching a plateau [16]. The incidence of malignancy after OHT is high [11,12,14,17], compared to other organs transplants. In European series, this could reach 30% at about 9 year follow-up and could be responsible for more than 20% of the fatalities after OHT [12].…”