title: Cardiac or cardiopulmonary transplantation in childhood cancer survivors: an increasing need?
abstract: Childhood cancer patients now have an excellent survival rate. Anthracyclines and radiation have contributed to this success, unfortunately at a cost. Both modalities are cardiotoxic and in some cases this is fatal unless treated by cardiac transplantation. This population-based study investigates the requirement for transplantation, patient demographics and transplant outcomes. Childhood cancer survivors requiring a subsequent cardiac or cardiopulmonary transplant were identified by record linkage between the National Registry Childhood Tumours (NRCT) and United Kingdom Transplant registry (UKT). The clinical details were obtained from the treatment centres for confirmed matches. Forty-three patients were identified as requiring cardiac transplantation: 36 underwent transplantation, 4 died while waiting and 3 were removed from the list. Their childhood cancers included 21 haematopoietic and 22 solid tumours diagnosed at a median age of 3.00 years (range 0.11-13.92 years). All patients were treated with anthracyclines (210-750 mg/m(2)) and 15 received cardiac radiation. The median age at cardiac transplantation was 14.80 years (range 3.26-23.92 years) and actuarial survival for the 36 who underwent cardiac transplantation was 74% and 67% at 5 and 10 years, respectively. A further three patients underwent heart/lung transplantation: all three died from transplant-related causes. Cardiac transplantation is a realistic option for cancer survivors, with survival rates comparable with those of other cardiac recipients. This study demonstrates that, over three decades, there has been an increased requirement for cardiac transplantation among childhood cancer survivors. Future planning for long term survivors needs to take this into account.
authors.affiliation: Department of Oncology and Haematology, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK. levitg@gosh.nhs.uk
authors.forename: Gill
authors.initials: G
authors.lastname: Levitt
authors.forename: Antoinette
authors.initials: A
authors.lastname: Anazodo
authors.forename: Michael
authors.initials: M
authors.lastname: Burch
authors.forename: Kathryn
authors.initials: K
authors.lastname: Bunch
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018943:Anthracyclines / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000601:surgery; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D016041:Heart-Lung Transplantation / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D020380:Needs Assessment; D009369:Neoplasms / Q000628:therapy*; D011832:Radiation Injuries / Q000209:etiology / Q000601:surgery; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents