title: Pre-transplant malignancy: an analysis of outcomes after thoracic organ transplantation.
abstract: BACKGROUND
  Pre-transplant malignancy (PTM) is a relative contraindication to organ transplantation. Studies examining the effect of PTM on outcomes after lung transplantation (LTx) or orthotopic heart transplantation (OHT) are limited. We evaluated the effect of PTM on outcomes after LTx and OHT.
  
  
  METHODS
  We retrospectively reviewed primary adult LTx and OHT recipients in the United Network for Organ Sharing database. Primary stratification was by PTM and secondary stratification by tumor type. Matched cohorts (2:1) and multivariable Cox proportional hazards regression models were used to evaluate mortality.
  
  
  RESULTS
  From 2000 to 2011, 13,613 adults underwent LTx and 19,817 underwent OHT. PTM was present in 740 LTx patients (5.4%) and in 1,117 OHT patients (5.6%). On unadjusted analysis, LTx patients and OHT patients with PTM had similar 30-day, 1-year, and 5-year survivals (p<0.05) compared with patients with no PTM. These findings persisted after risk-adjustment . No tumor types were associated with increased mortality in LTx patients. OHT patients with leukemia, lymphoma, or myeloma (LLM) had a significant increase in univariate mortality at 30 days (hazard ratio [HR], 1.82; p = 0.04), 1 year (HR, 1.93; p<0.001), and 5 years (HR, 1.54; p = 0.01). Matched cohort analysis revealed comparable outcomes in LTx patients but confirmed increased univariate 1-year mortality (HR, 1.89; p = 0.006) in OHT patients with LLM.
  
  
  CONCLUSIONS
  This large study evaluating the effects of PTM found the incidence of PTM was in LTx 5.4% and in OHT 5.6%. In general, PTM does not increase mortality in either cohort; however, OHT patients with LLM have an increased hazard of mortality. Therefore, carefully selected patients with PTM should not be excluded from LTx or OHT.
authors.affiliation: Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
authors.forename: Claude A
authors.initials: CA
authors.lastname: Beaty
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: George
authors.forename: Arman
authors.initials: A
authors.lastname: Kilic
authors.forename: John V
authors.initials: JV
authors.lastname: Conte
authors.forename: Ashish S
authors.initials: AS
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D000075202:Contraindications; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D018579:Patient Selection; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology