Purpose: While evidence suggests that patients undergoing simultaneous heart-liver and heart-kidney transplant may have improved immunoprotection from allograft rejection versus patients undergoing heart transplant only, it is unclear whether this translates to differences in post-transplant malignancy rates. We compared malignancy outcomes in patients undergoing heart only versus simultaneous heart-liver/kidney transplant.

Methods: The United Network for Organ Sharing database was retrospectively queried from 1987 to 2015 for simultaneous heart-liver, heart-kidney, and heart-liver-kidney transplant (SHT, n=1379) versus heart only transplants (HT, n=61471). Statistical analysis included Kaplan-Meier, Cox regression, and multivariable regression analyses.

Results: 2572 patients (4.18%) in HT and 107 patients (7.75%) in SHT had pretransplant malignancy. Within HT and SHT, Cox regression showed that pretransplant malignancy was significantly associated with post-transplant malignancy (hazard ratio (HR) 2.39, p<0.001 for HT; HR 2.88, p<0.001 for SHT). Kaplan-Meier analysis showed similar freedom from post-transplant malignancy between HT versus SHT in patients without pretransplant malignancy (Figure 1A; log rank p=0.53). For patients with pretransplant malignancy (Figure 1B), lower freedom from malignancy was noted in SHT during the early post-transplant period (Wilcoxon test p=0.03). Multivariable analysis showed age >60 years (odds ratio (OR) 3.38; p<0.001), history of smoking (OR 1.21, p=0.007), and pretransplant malignancy (OR 1.86; p<0.001) as highly significant risk factors for post-transplant malignancy, but not the type of transplant (HT versus SHT, OR 1.31; p=0.38).

Conclusions: Overall, malignancy rates are similar in patients undergoing heart only versus simultaneous heart-liver/kidney transplant. However, in patients with pretransplant malignancy, increased malignancy rates are seen in SHT patients during the early post-transplant period.

CITATION INFORMATION: Chin A, Habertheuer A, Chou A, Acker M, Williams M, Atluri P, Bermudez C, Vallabhajosyula P. Malignancy in Patients Undergoing Simultaneous Heart-Liver and Heart-Kidney Transplant. Am J Transplant. 2017;17 (suppl 3).

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