INTRODUCTION
In 1969, Drs. Penn and Starzl first published their observation of five
renal transplant patients who developed malignant lymphomas and
cautioned about the risk of malignancy in transplant patients on
long-term immunosuppression.1 Since that time, many
have published on the increased incidence of posttransplant malignancy
compared to the general population, with immunosuppressive therapy and
oncologic viral infections suggested as two causative
etiologies.2–5 These malignancies include lymphomas
and the transplant-specific entity of post-transplant
lymphoproliferative disorder (PTLD), as well as solid-organ
malignancies. Post-transplant patients are at particularly increased
risk of skin cancers, Kaposi sarcomas, and genitourinary
carcinomas.3,6
Heart transplant patients are at even higher risk than other solid organ
transplant recipients due to greater need for
immunosuppression.7,8 At the same time, post-heart
transplant survival has improved over time with improvements in
immunosuppression, infectious disease prophylaxis, perioperative care,
and postoperative monitoring. The median survival for patients
undergoing heart transplants between 2002 to 2009 is 12.5 years, an
improvement from 10.5 years in 1992-2001.9 The risk of
post-transplant de novo malignancy (DNM) poses a threat to
further survival improvement. Previous literature has suggested that
calcineurin inhibitors specifically increase the risk of malignancy,
whereas mycophenolate mofetil (MMF) and mTOR inhibitors decrease the
risk.8,10–12 We sought to examine rates of malignancy
development in adult heart transplant patients, compare them to the
general population, and identify potentially modifiable risk factors.