Lung Cancer after Heart Transplantation: Results from a Large Multicenter Registry

Crespo-Leiro, María G.; Villa-Arranz, Adolfo; Manito-Lorite, Nicolás; Paniagua‐Martin, María J.; Rábago, Gregorio; Almenar‐Bonet, Luis; Alonso‐Pulpón, Luis; Mirabet‐Pérez, Sónia; Díaz‐Molina, Beatriz; González‐Vílchez, Francisco; Prado, J. M. Arizón de; Romero-Rodríguez, Nieves; Delgado-Jiménez, Juan; Roig, Eulàlia; Blasco‐Peiró, Teresa; Pascual-Figal, Domingo A.; Galán, Luis de la Fuente; Muñiz, Javier

doi:10.1111/j.1600-6143.2011.03515.x

Cited by 27 publications

(19 citation statements)

References 26 publications

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“…We also found that organ transplant recipients with de novo lung cancer diagnoses were more likely to present with early stage lung cancer than non-transplanted patients. This differs from previous studies of lung cancer in organ transplant recipients that reported higher rates of late stage lung cancers(11, 26, 28). Two of those studies did not have comparison groups, and all were much smaller than the current analysis, and not population-based.…”

Section: Discussioncontrasting

confidence: 99%

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Lung Cancer Prognosis in Elderly Solid Organ Transplant Recipients

et al. 2015

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Background Treatment-related immunosuppression in organ transplant recipients has been linked to increased incidence and risk of progression for several malignancies. Using a population-based cancer cohort, we evaluated whether organ transplantation was associated with worse prognosis in elderly patients with non-small cell lung cancer (NSCLC). Methods Using the Surveillance, Epidemiology and End Results registry linked to Medicare claims we identified 597 patients age ≥65 with NSCLC who had received organ transplants (kidney, liver, heart or lung) prior to cancer diagnosis. These cases were compared to 114,410 untransplanted NSCLC patients. We compared overall survival (OS) by transplant status using Kaplan-Meier methods and Cox regression. To account for an increased risk of non-lung cancer death (competing risks) in transplant recipients, we used conditional probability function (CPF) analyses. Multiple CPF regression was used to evaluate lung cancer prognosis in organ transplant recipients while adjusting for confounders. Results Transplant recipients presented with earlier stage lung cancer (p=0.002) and were more likely to have squamous cell carcinoma (p=0.02). Cox regression analyses showed that having received a non-lung organ transplant was associated with poorer OS (p<0.05) while lung transplantation was associated with no difference in prognosis. After accounting for competing risks of death using CPF regression, no differences in cancer-specific survival were noted between non-lung transplant recipients and non-transplant patients. Conclusions Non-lung solid organ transplant recipients who developed NSCLC had worse OS than non-transplant recipients due to competing risks of death. Lung cancer-specific survival analyses suggest that NSCLC tumor behavior may be similar in these two groups.

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Section: Discussioncontrasting

confidence: 99%

“…We found higher rates of NSCLC with squamous cell histology in transplant recipients, a finding also reported in prior studies(26, 28). A possible explanation for the predominance of squamous cell cancers in patients who received transplants is that chronic immunosuppression diminishes T-cell mediated control of viral infections.…”

Section: Discussionsupporting

confidence: 91%

Lung Cancer Prognosis in Elderly Solid Organ Transplant Recipients

et al. 2015

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“…Noncutaneous solid tumors arose in 14.3% of patients with PT (three considered relapsing malignancies [two colon carcinomas, one bladder carcinoma]) and 9.3% of patients with NPT. Lung cancer was the most common one, in agreement with data from a study assessing post‐HT lung cancer incidence and other studies showing lung cancer as one of the most frequently developing solid tumors in HT recipients . Hematologic tumors developed in 3.9% (three of 77) of PT patients (one tumor was multiple myeloma, considered a relapsing malignancy) and 2.4% (108 of 4484) of NPT patients.…”

Section: Discussionsupporting

confidence: 87%

Cancer Incidence in Heart Transplant Recipients With Previous Neoplasia History

Delgado

Alonso‐Pulpón

Mirabet

et al. 2016

American Journal of Transplantation

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Neoplasm history increases morbidity and mortality after solid organ transplantation and has disqualified patients from transplantation. Studies are needed to identify factors to be considered when deciding on the suitability of a patient with previous tumor for heart transplantation. A retrospective epidemiological study was conducted in heart transplant (HT) recipients (Spanish Post-Heart Transplant Tumor Registry) comparing the epidemiological data, immunosuppressive treatments and incidence of post-HT tumors between patients with previous malignant noncardiac tumor and with no previous tumor (NPT). The impact of previous tumor (PT) on overall survival (OS) was also assessed. A total of 4561 patients, 77 PT and 4484 NPT, were evaluated. The NPT group had a higher proportion of men than the PT group (p < 0.001). The incidence of post-HT tumors was 1.8 times greater in the PT group (95% confidence interval [CI] 1.2-2.6; p < 0.001), mainly due to the increased risk in patients with a previous hematologic tumor (rate ratio 2.3, 95% CI 1.3-4.0, p < 0.004). OS during the 10-year posttransplant period was significantly lower in the PT than the NPT group (p = 0.048) but similar when the analysis was conducted after a first post-HT tumor was diagnosed. In conclusion, a history of PT increases the incidence of post-HT tumors and should be taken into account when considering a patient for HT.

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“…We know of no studies in the transplant literature that have reported this association 45. Both smoking and medication nonadherence are important known risk factors for poor clinical outcomes following HTx 2, 46…”

Section: Discussionmentioning

confidence: 99%

Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

Denhaerynck

Berben

Dobbels

et al. 2018

American Journal of Transplantation

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Factors at the level of family/healthcare worker, organization, and system are neglected in medication nonadherence research in heart transplantation (HTx). The 4‐continent, 11‐country cross‐sectional Building Research Initiative Group: Chronic Illness Management and Adherence in Transplantation (BRIGHT) study used multistaged sampling to examine 36 HTx centers, including 36 HTx directors, 100 clinicians, and 1397 patients. Nonadherence to immunosuppressants—defined as any deviation in taking or timing adherence and/or dose reduction—was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale© (BAASIS ©) interview. Guided by the Integrative Model of Behavioral Prediction and Bronfenbrenner's ecological model, we analyzed factors at these multiple levels using sequential logistic regression analysis (6 blocks). The nonadherence prevalence was 34.1%. Six multilevel factors were associated independently (either positively or negatively) with nonadherence: patient level: barriers to taking immunosuppressants (odds ratio [OR]: 11.48); smoking (OR: 2.19); family/healthcare provider level: frequency of having someone to help patients read health‐related materials (OR: 0.85); organization level: clinicians reporting nonadherent patients were targeted with adherence interventions (OR: 0.66); pickup of medications at physician's office (OR: 2.31); and policy level: monthly out‐of‐pocket costs for medication (OR: 1.16). Factors associated with nonadherence are evident at multiple levels. Improving medication nonadherence requires addressing not only the patient, but also family/healthcare provider, organization, and policy levels.

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Lung Cancer after Heart Transplantation: Results from a Large Multicenter Registry

Cited by 27 publications

References 26 publications

Lung Cancer Prognosis in Elderly Solid Organ Transplant Recipients

Lung Cancer Prognosis in Elderly Solid Organ Transplant Recipients

Cancer Incidence in Heart Transplant Recipients With Previous Neoplasia History

Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

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