Risk Factors for Development of Malignancy
Male gender conferred a 24% increased risk of developing malignancy
post-heart transplant (95% CI 1.17-1.31, p<0.001).
(Table 3 ). Hispanic (HR 0.78, 95% CI 0.70-0.87) and Asian race
(HR 0.68, 95% CI 0.55-0.84) were associated with lower risk of
developing malignancy as compared to Caucasian race (p<0.001).
Patients with DNM were older at the time of their transplant than
patients without (53.8 vs. 51.4 years, p<0.001), with
increasing age conferring a 2% increased risk of malignancy development
(95% CI 1.02-1.03 p<0.001). A history of cigarette smoking
also increased the risk by 39% (95% CI 1.27-1.53, p<0.001),
as did recipient hepatitis B virus (HBV) core antibody positivity (HR
1.19, 95% CI 1.04-1.35, p=0.01). The average GFR at time of transplant
of patients who later developed DNM was lower than those who did not
(66.1 vs. 70.6 mL/min/1.73m2, p<0.001) and
requiring dialysis post-transplant particularly increased the risk of
malignancy development (HR 1.17, 95% CI 1.03-1.33, p=0.01).
The use of induction therapy at the time of transplant was not
associated with post-transplant malignancy on regression analysis
(p=0.58), and this remained true when looking specifically at induction
with basiliximab (p=0.70) or with anti-thymocyte globulin (ATG) (p=0.94)
(Table 3 ). On Cox regression, the use of calcineurin inhibitors
(p=0.07), mTOR inhibitors (p=0.09), and steroids (p=0.66) were not
associated with malignancy risk, but MMF was associated with a reduced
risk (HR 0.89, 95% CI 0.83-0.96, p=0.001).