*Purpose: The purpose of this study is to investigate pre-transplant malignancy (PTM) as a risk factor for worsened post-transplant prognosis in heart or lung transplant recipients. The study also examines the effect of PTM on mortality, graft failure, and post-transplant malignancy. Determining the type of pre and post-transplant malignancies in heart or lung transplant recipients will also help our understanding of the prognosis of thoracic organ transplantation.

*Methods: For this retrospective cohort study with secondary data analysis, we evaluated the United Network for Organ Sharing registry for adults older than 18 years old. We analyzed heart transplants and lung transplants that were conducted between July 2004 and March 2015 for mortality and post-transplant malignancy analysis. Post-transplantation follow-up data collected up to March 2019 is used to evaluate post-transplantation outcomes, including post-transplantation malignancy, graft failure, and mortality. Cox proportional hazard regressions with multi-variable adjustment were calculated.

*Results: There were 22,284 heart and 20,489 lung transplants conducted between July 2004 and March 2019 in the US. 253 Heart and lung concomitant transplantation were performed during the same period of time. After multivariate adjustment, heart recipients with pre-transplantation leukemia and lymphoma had a significantly higher risk for graft failure (HR 1.33, p 0.000, median time to graft failure 767 days, p 0.024) compared with patients with no PTM (1262 days). Pre-transplant breast cancer also increased risk of graft failure in heart recipients (HR 1.16, p 0.010). Heart transplant recipients with leukemia and lymphoma also showed shorter median survival time (1826 days, p value 0.000) compared with no PTM recipients (2196 days). Lung recipients with pre-transplant skin cancer (HR 1.26, p 0.000) and genitourinary cancer (HR 1.26, p 0.003) showed higher risk of graft failure. This trend continues to higher mortality of lung recipients with genitourinary PTM (HR 1.48, p 0.001). Post-transplantation malignancy risk was also significantly higher in heart recipients with pre-transplant leukemia (HR 1.54, p 0.019), skin (HR 2.52, p 0.000), breast (HR 1.45, p 0.021), or genitourinary cancer (HR 1.55, p 0.009). In lung recipients, skin cancer was the only PTM which increased the risk of post-transplantation malignancy (HR 1.81, p 0.000).

*Conclusions: This large study evaluating the impact of PTM on heart or lung transplantation found the risk of graft failure, mortality, and post-transplantation malignancy is higher with certain PTM. Therefore, the treatment plan for heart or lung recipients with PTM history needs to take this into consideration.

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