title: Incidence and prognosis of cancer following heart transplantation using RATG induction therapy.
abstract: Cancer limits survival following heart transplantation. The study's objectives were to evaluate the incidence and risk factors for cancers after heart transplantation and to assess the association between i.v. thymoglobuline induction therapy [rabbit antithymocyte immunoglobulin, (RATG)] and neoplasia. From 1982 to 2002, prospective data were gathered for 207 heart transplant recipients. Except from 1982 to 1987, all patients received a 3-day course of i.v. RATG following transplantation. Forty-three malignant neoplasms (21%) were diagnosed. The most common were: skin (42%), lung (12%), prostate (9%), genitourinary (9%) and lymphoma (5%). Mean length of follow-up after transplantation was 99 +/- 57 months. Mean survival after diagnosis was 52 +/- 44 months. Multivariate analysis showed no significant increase in the incidence of cancer with recipient age, sex, number of rejection episodes, the type of immunosuppression or the use of RATG. Patients receiving RATG developed their malignancies significantly earlier after transplantation (P =0.007) and succumbed faster after the diagnosis (P = 0.06). Cancer is a limiting event for long-term survival after heart transplantation. No individual risk factors allow predicting its development. In the present cohort, RATG does not have carcinogenic effects following transplantation, but is associated with a more precocious development of malignancies.
authors.affiliation: Department of Cardiovascular Surgery, Montreal Heart Institute and University of Montreal, Quebec, Canada.
authors.forename: Ismaïl
authors.initials: I
authors.lastname: El-Hamamsy
authors.forename: Louis-Mathieu
authors.initials: LM
authors.lastname: Stevens
authors.forename: Michel
authors.initials: M
authors.lastname: Carrier
authors.forename: Guy
authors.initials: G
authors.lastname: Pelletier
authors.forename: Michel
authors.initials: M
authors.lastname: White
authors.forename: Francine
authors.initials: F
authors.lastname: Tremblay
authors.forename: Louis P
authors.initials: LP
authors.lastname: Perrault
mesh_terms: D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology* / Q000517:prevention & control; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods / Q000706:statistics & numerical data; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000961:Antilymphocyte Serum