title: A multi-institutional study of malignancies after heart transplantation and a comparison with the general United States population.
abstract: BACKGROUND
  The purpose of these studies was to determine the incidence and survival of patients with specific malignancies with respect to age and transplant year and to compare the data with the normal non-transplant population.
  
  
  METHODS
  Data from 6,211 primary cardiac transplants between July 31, 1993, and December 30, 2008, were collected by 35 institutions participating in the Cardiac Transplant Research Database. Data were compared with information collected by the Surveillance Epidemiology and End Results (SEER) Cancer Statistics Review 1975-2006.
  
  
  RESULTS
  Multivariable analysis showed older age (relative risk [RR], 2.1; p < 0.0001) and earlier transplant year (RR, 1.8; p < 0.0001) were highly significant risk factors. Aggregate malignancy incidence in the modern era (2001 to 2008) did not differ significantly from the normal population, which appeared to be attributable to a lower rate of malignancies other than lung cancer, lymphoma, and melanoma (actual/expected ratio, 0.71). From 2001 to 2008, rates were significantly higher for lung cancer (actual/expected ratio, 1.86; p = 0.006) and lymphoma (actual/expected ratio, 4.3, p < 0.0001) than in the normal population. The highest risk for lymphoma was in younger adults who received transplants at ages 18 to 35 years (actual/expected ratio, 27). The highest risk for lung cancer was in patients who underwent transplantation at ages 55 to 65 years (actual/expected ratio, 28). Once diagnosed with malignancy, subsequent survival at 5 years was 21% for lung cancer and 32% for lymphoma.
  
  
  CONCLUSIONS
  The risk of malignancy has markedly declined during a 15-year period such that the aggregate rate of malignancy approached that of the general population in the United States. However, the distribution of malignancies was not the same, with a greater prominence of lung cancer and lymphoproliferative disease.
authors.affiliation: Ohio State University Medical Center, Columbus, Ohio.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Higgins
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Brown
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Chang
authors.affiliation: Cleveland Clinical Foundation, Cleveland, Ohio.
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Ewald
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Tallaj
authors.affiliation: Ohio State University Medical Center, Columbus, Ohio.
authors.forename: James K
authors.initials: JK
authors.lastname: Kirklin
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: jgeorge@uab.edu.
authors.forename: James F
authors.initials: JF
authors.lastname: George
mesh_terms: D000293:Adolescent; D000328:Adult; D005500:Follow-Up Studies; D005544:Forecasting; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: hazard; heart transplantation; lung cancer; lymphoma; malignancy; multi-institutional studies; statistics