Cancer incidence and mortality after heart transplantation - A population-based national cohort study

• Published in: Acta oncologica 2019-06, Vol.58 (6), p.859-863
• Main Authors: Jäämaa-Holmberg, Salla, Salmela, Birgitta, Lemström, Karl, Pukkala, Eero, Lommi, Jyri
• Format: Article
• Language: English
• Subjects: Adult; Cohort Studies; Female; Finland - epidemiology; Follow-Up Studies; Heart Diseases - mortality; Heart Diseases - surgery; Heart Transplantation - adverse effects; Heart Transplantation - mortality; Humans; Incidence; Male; Middle Aged; Neoplasms - epidemiology; Neoplasms - etiology; Postoperative Complications; Prognosis; Registries - statistics & numerical data; Risk Factors; Survival Rate
• ISSN: 0284-186X; 1651-226X
• DOI: 10.1080/0284186X.2019.1580385

Background: Cancer is currently one of the most important factors affecting the long-term health and survival of heart transplant patients. Material and methods: We calculated the standardized incidence ratios (SIR) for different cancer sites and the cancer-specific standardized mortality ratio (SMR) by linking a cohort of 479 adult heart transplant recipients transplanted in 1985-2014 (4491.6 person-years of follow-up) with data from the national Finnish Cancer Registry until the end of 2015, and with the data from the Statistics Finland's national registry of causes of death. Results: A total of 267 cancers occurred in 143 patients (SIR 6.0; 95% confidence interval (CI) 5.3-6.7). The SIR for overall cancer was considerably higher for men (SIR 6.7; 95% CI 5.9-7.5) than for women (1.4; 95% CI 0.6-2.6). Most frequent cancers were non-melanoma skin cancers (basal cell carcinoma 83 cases, squamous cell skin cancer (SCC) 56 cases), followed by Non-Hodgkin lymphoma (NHL) (36 cases), lung cancer (17), cancer of prostate (16) and cancer of kidney (12). SIRs were highest for SCC (51.9; 95% CI 39.2-67.4), lip cancer (47.4; 95% CI 19.1-97.7), cancer of tongue (26.3; 95% CI 7.2-67.4), and NHL (25.7; 95% CI 18.0-35.6). For most cancers, SIRs increased steadily by time since transplantation. Cancer mortality was three times higher for heart transplant recipients than for the population (SMR 3.1; 95% CI 2.1-4.1). Conclusions: Both cancer incidence and mortality are remarkably increased after heart transplantation, with the relative incidence most elevated for SCC, lip and other oral cancers, and for NHL.