Incidence, Risk Factors And Research Progress Of Tumors After Heart Transplantation

Background:malignant is a major problem affecting long-term overall survival after heart transplantation(HT).However,the incidence,risk factors and prognosis of de novo malignancy(DNM)after transplantation in China are mostly focused on specific organ transplantation.Objective:this study retrospectively analyzed 689 cases of heart transplantation in fuwai heart transplantation database with a follow-up time of more than 1 year and a clear record of immunosuppression after transplantation,focusing on the incidence,risk factors and medium and long-term survival rate of heart transplantation recipients with DNM.Methods:The cumulative incidence of malignant in each subgroup was assessed by kaplan-meier survival analysis,and the survival rate of malignant recipients was compared by log-rank test.Cox regression analysis was used to evaluate the risk factors of new tumor after heart transplantation.Results:The incidence of malignant in our transplant recipients at 1,3,5,10 and 15 years was 0.1%,0.3%,1.2%,4.7%and 10.2%,respectively.Age is an independent risk factor for de novo malignancy in heart transplant recipients.With the extension of transplantation time,the risk of DNM after transplantation increases extra about 10%at the 1,3,and 5 years for each additional of recipient age,while the risk of DNM after transplantation increases by 1-2 times at the 1,3 and 5 years for each additional 10 years of recipient age.The median time for the diagnosis of DNM after transplantation was 47 months(IQR 20,74),and there was no significant statistically difference between transplant recipients with DNM and those without malignant(54 months vs.70 months)(P=0.121).The median survival time of DNM recipients was 7 months(IQR 4,38)with the longest survival time of 88 months.Survival was significantly reduced in elderly recipients,those with a history of diabetes and smoking,and those with cyclosporine,while tacrolimus was negatively associated with the risk of malignant.Conclusion:the incidence of malignant in our heart transplant recipients is low.Age is an independent risk factor for de novo malignancy in heart transplant recipients.Cyclosporine,tacrolimus and AB blood,preoperative history of diabetes,smoking history and transplantation etiology were also risk factors for neoplasia.Heart transplantation is the last treatment for a variety of the end-stage heart disease,and malignant is one of the main factors affecting the prognosis with the improvement of the survival rate of heart transplant.The overall malignant incidence of transplant recipients is 3-5 times higher than that of the general population,and immunosuppressive therapy increases the long-term risk of malignant in transplant patients.The sources of malignant in heart transplant recipients can be roughly divided into three categories:de novo malignancy(DNM),malignant spread by donors with a cancer history(DWCH),and the metastasis or recurrence of pretransplant malignancies(PTM).The purpose of this article is to summarize the current progress in the study of heart transplantation related malignant.