Management of Patients with Malignancy before Heart Transplantation

Wilhelm Mistiaen — Sat, 10 Oct 2020 00:00:00 -0400

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 â€œheart 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.

Int. J. of Cardiology and Lipidology Research

Management of Patients with Malignancy before Heart Transplantation