Donor history of malignancy: A limited risk for heart transplant recipients

Abstract

Organ donor contraindications are frequently reassessed for impact on recipient outcomes in attempt to meet demand for transplantation. This study retrospectively analyzed the United Network for Organ Sharing (UNOS) registry for adult heart transplants from 1987 to September 2016 to characterize the impact of donor malignancy history in heart transplantation. Kaplan‐Meier estimates illustrated 10‐year survival. Propensity score matching was utilized for 1:1 matching of donors with and without history of malignancy, and Cox proportional hazards and logistic regressions were used to analyze the matched population. Of 38 781 heart transplants, 622 (1.6%) had a donor history of malignancy. Cox regressions demonstrated that donor malignancy predicted increased 10‐year mortality (HR = 1.16 [1.01‐1.33]), but this difference did not persist when conditioned upon 1 year post‐transplant survival (log‐rank = 0.643). Cox regressions of the propensity score‐matched population (455 pairs) found no association between donor malignancy and 10‐year mortality (HR = 1.02 [0.84‐1.24]). Older age and higher rates of hypertension were observed in donors with a history of malignancy whose recipients died within the first year post‐transplant. Therefore, increased recipient mortality is likely due to donor characteristics beyond malignancy, creating the potential for expanded donor selection.

Management of Patients with Malignancy before Heart Transplantation

“…Although presence of such malignancy was a predictor for 10-year survival in the first series, this effect disappeared after propensity score matching or after conditioning upon 1-year post-transplant survival. Factors unrelated to malignancy were of more importance [18]. In the other series, a history of hematologic and otorhinolaryngologic malignancy in donors seemed more a problem for OHT in terms of graft and patient survival.…”

“…Overall, four out of five series showed that post-transplant survival of patients with a history of PTM or CCMP had not decreased. Two remarkable designs dealt with prior malignancy, present in cadaveric donors [18,19]. Although presence of such malignancy was a predictor for 10-year survival in the first series, this effect disappeared after propensity score matching or after conditioning upon 1-year post-transplant survival.…”

Posicionamento sobre Doença Isquêmica do Coração – A Mulher no Centro do Cuidado – 2023

“… 328 Rudasill et al , em recente análise do registro United Network for Organ Sharing (UNOS), não mostraram associação de malignidade do doador com a sobrevida do receptor em 10 anos. 333 No entanto, um histórico de malignidade pré-transplante no receptor foi associado a um risco aumentado de malignidade pós-transplante, especialmente de neoplasias cutâneas. Houve, no entanto, incidência menor nas mulheres.…”

“…Outras variáveis associadas à mortalidade em 5 anos, condicionadas à sobrevida em 1 ano, incluem idade do receptor, IMC, resistência vascular pulmonar, função renal, idade do doador e volume de cirurgias do centro de transplante 323. O gênero feminino é um forte preditor de mortalidade em lista de espera para transplante cardíaco [326][327][328][329][330][331][332][333][334][335]. No entanto, sexo não foi demonstrado como uma variável significativa ou importante associada à mortalidade pós-transplante, com poucas interações do gênero como preditor de mortalidade, apesar de as mulheres viverem mais que os homens 336.…”

Bugs at the operating theatre in infective endocarditis: one step forward, still a long way to go

“…Also regrettable is the lack of information regarding the use of intravenous drugs in the sample, since it would have enabled the authors to link their findings with the increase in IE among intravenous drug users (IDUs) in the context of the current opioid crisis. Even though the study period (2011 to 2016) would have not captured the peak of the epidemics, a recent nationwide study has shown a significant increase in IDUs-IE admissions between 2010 and 2015 (37). In any case, comparing the rates of surgery and recidivism among IDUs with those of the nineties, especially in patients with HIV infection, is a burgeoning field of interest.…”