Rate of Malignancy Development
Over a median follow-up period of 6.9 years (IQR 3.1-11.6 years), a total of 9,150 de novo malignancies (DNM) were diagnosed in 18.3% of patients (n=9,006) after heart transplantation. Malignancy was diagnosed, on average, 8.0 years (SD 5.3 years) after transplantation.
At one-year post-transplant, the incidence of DNM development was 1.4%. At three, five, and ten years post, malignancies developed in 5.6%, 10.2%, and 20.7% of patients, respectively (Figure 2 ).
The most common malignancies were lung (22.3%, incidence rate of 443 per 100,000 person-years), post-transplant lymphoproliferative disease (PTLD) (16.5%, 316 per 100,000 person-years), and prostate (16.4%, 425 per 100,000 person-years in men). Compared to the general population in the SEER database, the incidence ratio (IR) of developing any DNM status-post heart transplantation is 3.8. IRs were highest for female genital cancer (11.2), tongue/throat cancer (7.4), renal carcinoma (6.5), and esophageal cancer (6.2) (Table 2 ).