Horizons in TransplantationThoracic transplantationCancer After Heart Transplantation: A 25-year Single-center Perspective

•Cancer is a major cause of morbidity and mortality after heart transplantation.•Cumulative incidence of cancer at 10 years after transplantation is almost 30%.•Age at transplantation >50 years and male recipient gender are independent risk factors for the development of posttransplant malignancy.•Strategies to individualize immunosuppression according to the recipient's immune status are needed.

BackgroundCancer is a major cause of morbidity and mortality after heart transplantation.MethodsWe studied 541 heart transplant patients from a single center over a period of 25 years, with a mean follow-up of 10.7 years. We determined incidence, type, risk factors, and prognosis for cancer after heart transplantation.ResultsCancer was diagnosed in 181 patients, at a mean of 7.7 years after transplantation. Cumulative incidence of cancer at 5, 10, and 20 years was 14%, 29%, and 60%, respectively. The most frequent cancers were spinocellular skin cancer (22%), basocellular skin cancer (19%), lung cancer (16%), lymphoma (11%) and prostate cancer (10%). Age at transplantation > 50 years (hazard ratio, 2.9; P < .001) and male recipient gender (hazard ratio, 1.7; P = .038) were significant risk factors for posttransplant malignancy on multivariate Cox proportional hazards analysis. Median patient survival after diagnosis of cancer was 2.9 years for patients with noncutaneous cancer, versus 13.1 years for patients with only skin cancer (P < .001).