title: Long-term follow-up of lung and heart transplant recipients with pre-transplant malignancies.
abstract: BACKGROUND
  Concern regarding recurrence of pre-transplant (Tx) malignancy has disqualified patients from Tx. Because this has been poorly studied in lung and heart Tx recipients our aim was to investigate the influence of pre-Tx malignancy on post-Tx recurrence and long-term survival, focusing on pre-operative cancer-free intervals.
  
  
  METHODS
  From our lung and heart Tx programs (1983 to 2011) we retrospectively identified 111 (lung, 37; heart, 74) of 3,830 recipients with 113 pre-Tx malignancies. The patients were divided into 3 groups by pre-Tx cancer-free interval: Group I, <12 months (n = 24); Group II, ≥12 to<60 months (n = 18); and Group III, ≥60 months (n = 71).
  
  
  RESULTS
  Mean age at pre-Tx malignancy was 35±18 years. Mean post-Tx follow-up time was 70±63 months (range, 0-278 months), and malignancy recurrence was 63% in Group I, 26% in Group II, and 6% in Group III. Kaplan-Meier analysis of freedom from post-Tx recurrence revealed the following differences among the groups: Group I vs II, p = 0.08; II vs III, p = 0.002; and I vs III, p<0.001. Overall survival (51 deaths) was significantly poorer in Group I than in Groups II and III (p = 0.044). Survival between Groups II and III did not differ significantly (p = 0.93).
  
  
  CONCLUSIONS
  Cancer-free survival of ≥5 years pre-Tx is associated with the lowest recurrence. However, recurrence is related to the time the patients were cancer-free, as seen in Groups I and II.
authors.affiliation: Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden. vilborg.sigurdardottir@insel.ch
authors.forename: Vilborg
authors.initials: V
authors.lastname: Sigurdardottir
authors.forename: Oystein
authors.initials: O
authors.lastname: Bjortuft
authors.forename: Hans
authors.initials: H
authors.lastname: Eiskjær
authors.forename: Bjorn
authors.initials: B
authors.lastname: Ekmehag
authors.forename: Einar
authors.initials: E
authors.lastname: Gude
authors.forename: Finn
authors.initials: F
authors.lastname: Gustafsson
authors.forename: Inger
authors.initials: I
authors.lastname: Hagerman
authors.forename: Maija
authors.initials: M
authors.lastname: Halme
authors.forename: Jyri
authors.initials: J
authors.lastname: Lommi
authors.forename: Lena
authors.initials: L
authors.lastname: Mared
authors.forename: Gerdt C
authors.initials: GC
authors.lastname: Riise
authors.forename: Svein
authors.initials: S
authors.lastname: Simonsen
mesh_terms: D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D009369:Neoplasms / Q000150:complications*; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors