Malignancy After Heart Transplantation: Incidence, Prognosis and Risk Factors

The Spanish Post‐Heart‐Transplant Tumour Registry comprises data on neoplasia following heart transplantation (HT) for all Spanish HT patients (1984–2003). This retrospective analysis of 3393 patients investigated the incidence and prognosis of neoplasia, and the influence of antiviral prophylaxis. About 50% of post‐HT neoplasias were cutaneous, and 10% lymphomas. The cumulative incidence of skin cancers and other nonlymphoma cancers increased with age at HT and with time post‐HT (from respectively 5.2 and 8.9 per 1000 person‐years in the first year to 14.8 and 12.6 after 10 years), and was greater among men than women. None of these trends held for lymphomas. Induction therapy other than with IL2R‐blockers generally increased the risk of neoplasia except when acyclovir was administered prophylactically during the first 3 months post‐HT; prophylactic acyclovir halved the risk of lymphoma, regardless of other therapies. Institution of MMF during the first 3 months post‐HT reduced the incidence of skin cancer independently of the effects of sex, age group, pre‐HT smoking, use of tacrolimus in the first 3 months, induction treatment and antiviral treatment. Five‐year survival rates after first tumor diagnosis were 74% for skin cancer, 20% for lymphoma and 32% for other tumors. Analysis of follow‐up data for 3393 Spanish heart transplant patients shows skin cancer to have a more favorable prognosis than other tumors, and suggests that prophylactic acyclovir counteracts the risk of neoplasia associated with certain induction treatments.