AUTHOR=Roest Stefan , Gürgöze Muhammed T. , Cherikh Wida S. , Stehlik Josef , Boersma Eric H. , Zijlstra Felix , Manintveld Olivier C. 

TITLE=Influence of chronic kidney disease and other risk factors pre-heart transplantation on malignancy incidence post-heart transplantation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1145996

DOI=10.3389/fcvm.2023.1145996

ISSN=2297-055X

ABSTRACT=Aims: Chronic kidney disease (CKD) pre-heart transplantation (HTx) has been proposed as a risk factor for malignancy risk post-HTx. Using multicenter registry data, our aim was to calculate the death-adjusted annual incidence of malignancy post-HTx, corroborate the association between CKD pre-HTx and malignancy risk post-HTx, and determine other risk factors for post-HTx malignancy. 
Methods and materials: We used data from patients transplanted in North American HTx centers between January 2000-June 2017 and registered in the International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry. We excluded recipients with missing data on post-HTx malignancy, heterotopic heart transplant, retransplantation, multi-organ transplantation, and patients with a total artificial heart pre-HTx. 
Results: Overall, 34 873 patients were included to determine the annual incidence of malignancies, 33 345 patients were included in the risk analyses. The incidence of any malignancy, solid-organ malignancy, post-transplant lymphoproliferative disease (PTLD), and skin cancer adjusted for death 15 years post-HTx, was 26.6%, 10.9%, 3.6%, and 15.8% respectively. Besides widely acknowledged risk factors, CKD stage ≥4 pre-HTx was associated with the development of all malignancies post-HTx (HR 1.17 compared to CKD stage 1, p=0.023), as well as solid-organ malignancies (HR 1.35, p=0.01), but not for PTLD (HR 0.73, p=0.057), and skin cancer (HR 1.06, p=0.59). 
Conclusion: Risk of malignancy post-HTx remains high. CKD stages ≥4 pre-HTx was associated with an increased risk for any malignancy and solid-organ malignancy post-HTx. Strategies to mitigate the impact of pre-HTx patient factors on the risk of post-HTx malignancy are needed.