title: Frequency and spectrum of metachronous malignancies in heart transplant recipients: a 11-year-experience at a German heart center.
abstract: OBJECTIVE
  Heart transplantation (HTX) has become an established therapy for patients with end-stage heart failure. However, cancer incidence has been shown to be increased in the context of transplant-associated immunosuppression. The objective of this study is to analyze the incidence, histological spectrum, treatment and survival of various cancer types in HTX patients.
  
  
  METHODS
  We evaluated retrospectively all patients who underwent orthotopic HTX between 2000 and 2011 at our hospital including those patients who underwent HTX in other centers, but did their routine follow-up examinations at our department because of changing residence.
  
  
  RESULTS
  142 patients had HTX performed at our center in the last 11 years and another 9 patients visited our department for monitoring after HTX performed at an external center (total: 151). Ten patients (6.6%) developed a metachronous malignancy (3 non-melanoma skin cancer, 2 lung cancer and 1 each parotid gland cancer, prostate cancer, renal cancer, urinary bladder cancer and ductal pancreatic cancer). The latency between HTX and the diagnosis of the secondary neoplasm ranged from 33 to 152 months (median 76 months; mean 88 months). In all cases, surgery with or without chemoradiation was the treatment for the metachronous cancer. While most cases followed a favorable course after appropriate surgical and/or oncological treatment, four tumors (1 salivary duct carcinoma, 1 urinary bladder carcinoma, 1 ductal pancreatic cancer and 1 skin cancer) revealed a remarkable aggressiveness with wide-spread metastatic disease at the time of diagnosis or shortly thereafter.
  
  
  CONCLUSIONS
  Incidence of various cancer types among HTX patients in this survey was consistent with previous studies, with lung and skin cancer as the commonest malignancies encountered. Regular cancer screening may be of benefit in reducing morbidity and mortality in these patients.
authors: Center of Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg Germany. thomas.strecker@uk-erlangen.de
authors: Thomas
authors: T
authors: Strecker
authors: Johannes
authors: J
authors: Rösch
authors: Michael
authors: M
authors: Weyand
authors: Abbas
authors: A
authors: Agaimy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005858:Germany / Q000453:epidemiology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
keywords: Heart transplantation; immunosuppression; lung cancer; pancreatic cancer; parotid gland cancer; secondary malignancy; skin cancer; urinary tract cancer