Clinical Characteristics And Outcomes Of Cancer Survivors Undergoing Heart Transplantation

Purpose Heart transplantation (HT) remains the gold standard treatment for advanced heart failure (HF). Cancer survivors (CS) are at increased risk of developing HF in general and in some cases advanced HF. New consensus statements for organ transplantation in CS support the utilization of HT amongst select CS . The aim of this study was to examine clinical characteristics and outcomes of CS undergoing HT. Methods Retrospective cohort study of patients undergoing HT at a large medical center between Jan 1, 2010 and October 2020. CS were defined as those with history of malignancy other than non-melanoma skin cancer (CA) prior to HT. Baseline demographics, CA history and survival data were obtained from electronic medical records. Results 57(10.2%) CS were identified out of total of 560 HT recipients during the study period. Median age at the time of transplantation was 60 (IQR 50-65) years, and 60% of patients were male. Common pre-transplant malignancies included 13 breast CA (22.8%), 13 leukemia/lymphoma (22.8%), 8 prostate CA (14%), and 4 testicular CA (7%). 24 CS (42.1%) had received previous anthracycline therapy, and 23 CS (40.4%) had received chest radiation. Median follow-up time post-transplantation was 3.2 years (IQR 1.6-6.9 years). At the end of the study period, 50 of 57 (87.7%) CS were alive. Causes of deaths included infection (n=4), recurrent CA (n=2), and primary graft failure (n=1). Overall 9 patients (15.8%) developed 10 malignancies post HT. 4 patients had recurrence of their prior CA (2 breast ,1 colon, 1 prostate), while 6 patients developed new primary CA (prostate, renal, thyroid, lung, melanoma, lymphoma). The Kaplan Meier 5 year CA free survival was 69.8%(CI 49.8-83.1) (Figure 1) Conclusion CS appear to be at high risk of CA recurrence after HT; however infection is the leading cause of death on short term follow up. Longer follow-up is needed to understand long-term outcomes in this heterogenous group of patients to guide listing criteria, immunosuppression and CA screening.