Management of Patients with Malignancy before Heart Transplantation

Abstract

Background: Heart transplantation and malignancy connect in several ways. Cancer can be an incidental finding, cancer treatment can also be the cause of end-stage heart failure, for which heart transplantation is necessary or malignancy can occur after transplantation, because of immune suppression.

Methods: This is a database search on Web of Science from 2010 on, with the term “heart transplant* AND (cancer OR malignancy)â€. This resulted in 3767 titles.

Results: Eight articles contained sufficient information about survival. In most series, a history of pre-transplant malignancy (PTM) did not affect survival, except for hematologic malignancy or short cancer-free pre-transplant interval. Other patient-related factors were usually more important. The effect of PTM on the rate of post-transplant malignancy followed a comparable pattern. In patients with chemotherapy-related cardiomyopathy, other causes than malignancy were more important.

Conclusions: The outcome for heart transplantation in patients with PTM is acceptable in terms of survival, and occurrence post-transplant malignancy. An appropriate PTM-free interval of two to five years seems necessary. Hematologic PTM has a worse outcome. Although the limitations of this review warrant caution with the interpretation of its results, increased post-transplant screening for malignancy and of use of proliferation signal inhibitors, due to their antineoplastic activity, could be cornerstones of the management of these patients.