PRETRANSPLANT MALIGNANCY IN CANDIDATES AND POSTTRANSPLANT MALIGNANCY IN RECIPIENTS OF CARDIAC TRANSPLANTATION

Background: Malignancy is generally considered a contraindication for cardiac transplantation, whereas secondary malignancy has been describ ed under chronic immunosuppression. Patients and methods: We report he re the frequency of malignancy encountered among the 495 patients eval uated at our cardiac transplant centre as well as the incidence and th e course of post-transplant malignancy among 129 consecutive patients who underwent cardiac transplantation, with a subsequent minimum follo w-up of 6 months. Results: A total of 10 out of 495 patients (2%) eval uated for heart transplantation presented with a history of previous m alignancy: 3 of them underwent transplantation (2 survive, 1 died) whe reas in the remaining 7 patients neoplasia was considered a contraindi cation for cardiac transplantation, and all 7 died (4 cardiac, 3 tumor -related deaths). Post-transplant malignancy was diagnosed in 10 of 12 9 patients (9%) 35 +/- 15 months after transplantation (6 skin cancers , 1 lymphoproliferative disease, 3 solid tumors). No significant assoc iation was found between post-transplant malignancy and primary prophy laxis with antithymocyte globulin (ATG) or murine antihuman T-cell mon oclonal antibodies (OKT3). Conclusion: These results confirm that pre- transplant malignancy is not an absolute contraindication for cardiac transplantation and that post-transplant follow-up must include carefu l monitoring of post-transplant malignancy.