CARDIAC TRANSPLANTATION IN CHILDHOOD-CANCER SURVIVORS IN GREAT-BRITAIN

The aim of this study was to identify patients treated in Great Britai n for childhood cancer and subsequently referred for cardiopulmonary t ransplantation in order to assess diagnosis, cancer treatment, managem ent and outcome. Computerised record linkage between the National Regi stry of Childhood Tumours and the national transplant database field a nd maintained by the United Kingdom Transplant Support Service Authori ty (UKTSSA) was used to identify patients. Verification and clinical d etails were then obtained from the oncology and transplant centres. 16 patients were identified from the 31992 cases of childhood malignancy diagnosed in Britain since 1970. These comprised 13 heart transplants , 2 heart/lung transplants and 1 patient who died while on the heart t ransplantation waiting list. All 14 potential heart transplant patient s had cardiomyopathy presumed secondary to anthracycline therapy. The original diagnoses were acute myeloblastic leukaemia (3), Wilms' tumou r (4), rhabdomyosarcoma (2) and one each of five different solid tumou rs. Median age at diagnosis was 44 months (range 4-165 months). Median anthracycline dose was 413 mg/m(2) (range 240-680 mg/m(2)). 13 of the 14 potential cardiac transplantation patients were more than 2 years from end of their cancer treatment before requiring transplantation an d the transplantation was performed 2-126 months after onset of cardia c failure at a median age of 163 months. Five year actuarial survival from transplantation was 74%. There was no recurrence of the original malignancy in any of these patients. Both heart/lung patients died, 3 and 11 months after the transplant. These heart transplantation data s uggest that, in Britain, survival compares favourably with that of pat ients whose heart transplant was required for other causes of cardiomy opathy. This indicates that patients successfully treated for childhoo d cancer should not be excluded from transplant programmes. Copyright (C) 1996 Published by Elsevier Science Ltd