Screening for solid organ malignancies prior to heart transplantation

Background. Prognosis of solid organ cancer in immunosuppressed hosts is ge nerally dismal. Therefore, every effort to identify patients with asymptoma tic carcinomas before transplantation should be encouraged. Methods. Sixty-seven patients referred for heart transplantation were exami ned adhering to the scheme proposed at the 24th Bethesda Conference. To inc rease the sensitivity of this work-up, the following items were added: tumo r marker assays (prostate-specific antigen in males, carcino embryogenic an tigen), abdominal ultrasound, CT scan of the abdomen and the thorax, mammog raphy/echography of the breasts, PAP smear, colonoscopy if carcino embryoge nic antigen abnormal or occult blood in stool, prostate echography if prost ate-specific antigen abnormal or prostate hypertrophy, Results. Carcinoma was detected in 10 of the 67 patients; for 8 patients of this cancer group, transplantation was denied. Importantly, 9 of the 10 ma lignancies were detected by means of the diagnostic items that were added t o the standard screening protocol. There were no significant differences be tween the cancer and the non-cancer group regarding mean age, sex, etiology of heart failure, and smoking history. Stratifying patients in younger (i. e., less than or equal to 54 years) and older (i.e., greater than or equal to 55 years) age groups showed a significantly greater proportion of older patients in the cancer group (8/10=80%) compared to the non-cancer group (2 5/57=44%), P=0.04. After a mean follow-up of 34 months, 5 of the 36 transpl anted patients developed a malignancy (4 skin carcinomas, 1 non-Hodgkin lym phoma). There have been no malignancy-related deaths until now. Conclusion. The importance of a thorough screening program in the triage of candidates with preexisting malignancies, especially in an older patient p opulation, is illustrated in this report.