Cardiac transplantation in survivors of lymphoma: a multi-institutional survey.
BACKGROUND
Cardiac transplantation has been successfully performed in patients with a history of presumably cured Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). Though the risk of recurrence is a major concern, the long-term influence of prior cancer and cancer therapy on posttransplant outcome has not been previously investigated.


METHODS
Questionnaires were sent to 130 cardiac transplant centers in the United States registered with the United Network for Organ Sharing. Data collected included patient demographics; type, stage, and timing of HD/NHL; treatment for HD/NHL; posttransplant immunosuppressive regimen, rejection history, and outcomes; and Epstein-Barr virus status.


RESULTS
Thirty-four cardiac transplant recipients with a previous history of HD (n=16) or NHL (n=18) were identified. HD patients averaged 41+/-15 years of age, with a mean disease-free interval of 15+/-9 years at the time of transplantation. NHL patients averaged 42+/-17 years of age with a mean disease-free interval of 10+/-9 years at the time of transplantation. The mean follow-up for the entire group was 50 months (range, 2 days to 136 months), and mean follow-up for the survivors was 67 months (range, 23-136 months). The 1-, 3-, 5-, 7-, and 10-year actuarial survival estimates for the entire group are 77%, 64%, 64%, 64%, and 50%, respectively. Actuarial survival was lower in HD patients (P=0.04) and in patients who had previously undergone splenectomy (P=0.008). Cox regression analysis identified only prior splenectomy (P=0.02) as an independent risk factor for mortality after cardiac transplantation with an adjusted relative risk of 6.2 (1.7-21.9, 95% confidence intervals).


CONCLUSIONS
Although the numbers are small, these data strongly suggest that there is an increased mortality risk for cardiac transplant recipients with prior HD who have undergone splenectomy.
Taylor
D O
DO
Department of Medicine, University of Utah Health Sciences Center, Salt Lake City Veterans Affairs Medical Center, LDS Hospital, USA.
Farhoud
H H
HH
Kfoury
G
G
Pham
S M
SM
Pigula
F A
FA
Kormos
R L
RL
Renlund
D G
DG
D000206:Actuarial Analysis; D018572:Disease-Free Survival; D005260:Female; D016027:Heart Transplantation / Q000401:mortality / Q000502:physiology; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000628:therapy; D008297:Male; D013156:Splenectomy; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D014481:United States