M Garlicki, K Wierzbicki, P Przybylowski, D Drop, M Biernat, P Rudzinski, B Olszewska, A Dziatkowiak
Ann Transplant 1998; 3(4): 41-47
Objectives and methods: 219 heart transplant recipients with survival over 3 months were retro- and prospectively analysed for the incidence of primary neoplasms. Patients received immunosuppressive drugs (cyclosporine A, azathioprine,steroids) with a 4-5 days induction course of Rabbit Anti-Thymocyte Immunoglobulin (RATG) or monoclonal antibodies induction /OKT3/ in some cases. Anti-rejection treatment consisted of pulse doses of methyloprednisolon or RATG. Results: 9 cases of malignancy (4,1%) with one case of pre-malignant liver condition (dysplasia gigantocellulare, 0.45%) were found (8M; IF; age: 45-67 y.o., x 57.7). Symptoms of neoplasms occurred 7-79 months (x 31,4) postoperatively. Skin carcinomas: planoepitheliale, spinocellulare, soft tissue neoplasms / mesenchymal sarcoma, larynx Ca planoepitheliale, lung: adenocarcinoma and Ca microcellulare, kidney Ca clarocellulare and post transplant non-Hodgkin lymphoma were diagnosed. Chemo- and radiotherapy, surgery and reduction of immunosuppression did not change the outcome of malignancy in 6 pts.; (regression- I pt was., remission- 2 pts). Patients died 7-86 months after Htx (x 41), 4-25 mos. (x 12.5) after suffering from first symptoms and 0-10 months (x 4,9) after pathology-based diagnosis of neoplasm. Conclusions:Heart transplant recipientshave an increased riskof carcinogenesis.The incidence of malignancies in the studied group is similar or even lower than in other reports.
Keywords: Heart Transplantation, Immunosuppression, Malignancy