Conditions Associated With the Onset of Cancer After Heart Transplant: Longitudinal Study in 335 Recipients

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Main Authors: Fabian Patauner, Filomena Boccia, Silvia Masini, Giuliana Autiero, Raffaella Gallo, Lorenzo Bertolino, Irene Mattucci, Daniela Pinto, Roberto Andini, Cristiano Amarelli, Rosa Zampino, Emanuele Durante‐Mangoni
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Published: Wiley 2025
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author Fabian Patauner
Filomena Boccia
Silvia Masini
Giuliana Autiero
Raffaella Gallo
Lorenzo Bertolino
Irene Mattucci
Daniela Pinto
Roberto Andini
Cristiano Amarelli
Rosa Zampino
Emanuele Durante‐Mangoni
author_facet Fabian Patauner
Filomena Boccia
Silvia Masini
Giuliana Autiero
Raffaella Gallo
Lorenzo Bertolino
Irene Mattucci
Daniela Pinto
Roberto Andini
Cristiano Amarelli
Rosa Zampino
Emanuele Durante‐Mangoni
Fabian Patauner
Filomena Boccia
Silvia Masini
Giuliana Autiero
Raffaella Gallo
Lorenzo Bertolino
Irene Mattucci
Daniela Pinto
Roberto Andini
Cristiano Amarelli
Rosa Zampino
Emanuele Durante‐Mangoni
collection Wiley Open Access
contents Conditions Associated With the Onset of Cancer After Heart Transplant: Longitudinal Study in 335 Recipients Fabian Patauner Filomena Boccia Silvia Masini Giuliana Autiero Raffaella Gallo Lorenzo Bertolino Irene Mattucci Daniela Pinto Roberto Andini Cristiano Amarelli Rosa Zampino Emanuele Durante‐Mangoni Clinical Transplantation ABSTRACT Cancer is among the major causes of death after heart transplant (HTx). Risk factors for cancer occurrence in this setting are not well established. This was a retrospective observational study of patients who underwent HTx between 2006 and 2019 and were followed up until May 2024. Clinical variables possibly associated with cancer were assessed with univariable and multivariable analyses. Survival analysis was carried out drawing Kaplan Meier curves and a Cox regression with time‐varying covariates were performed to overcome the immortal‐time‐bias. Three‐hundred‐thirty‐five HTx recipients were included, of whom 42 (12.5%) developed cancer after a median of 6.3 years. In univariable analysis, older age at HTx, smoking history, alcohol use, male sex, ischemic heart disease before HTx, use of cyclosporine rather than tacrolimus, and increased length of follow‐up were associated with cancer. Upon multivariable analysis, ischemic heart disease (OR 2.70 [1.19–6.11], p  = 0.017) and length of follow‐up (OR 1.02 [1.00–1.04], p  = 0.007) were independently associated with cancer occurrence. Cox regression revealed a higher risk of mortality among patients with cancer (HR 3.400, [2.026–5.709], p  < 0.001). HTx recipients with prior ischemic cardiomyopathy and a longer survival time after transplant show a higher risk of developing cancer. Cancer significantly impairs post‐transplant survival. 10.1111/ctr.70243 http://creativecommons.org/licenses/by/4.0/
doi_str_mv 10.1111/ctr.70243
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id wiley_oa_10_1111_ctr_70243
institution Wiley Open Access
license_str_mv http://creativecommons.org/licenses/by/4.0/
publishDate 2025
publisher Wiley
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spellingShingle Conditions Associated With the Onset of Cancer After Heart Transplant: Longitudinal Study in 335 Recipients
Fabian Patauner
Filomena Boccia
Silvia Masini
Giuliana Autiero
Raffaella Gallo
Lorenzo Bertolino
Irene Mattucci
Daniela Pinto
Roberto Andini
Cristiano Amarelli
Rosa Zampino
Emanuele Durante‐Mangoni
Clinical Transplantation
Conditions Associated With the Onset of Cancer After Heart Transplant: Longitudinal Study in 335 Recipients Fabian Patauner Filomena Boccia Silvia Masini Giuliana Autiero Raffaella Gallo Lorenzo Bertolino Irene Mattucci Daniela Pinto Roberto Andini Cristiano Amarelli Rosa Zampino Emanuele Durante‐Mangoni Clinical Transplantation ABSTRACT Cancer is among the major causes of death after heart transplant (HTx). Risk factors for cancer occurrence in this setting are not well established. This was a retrospective observational study of patients who underwent HTx between 2006 and 2019 and were followed up until May 2024. Clinical variables possibly associated with cancer were assessed with univariable and multivariable analyses. Survival analysis was carried out drawing Kaplan Meier curves and a Cox regression with time‐varying covariates were performed to overcome the immortal‐time‐bias. Three‐hundred‐thirty‐five HTx recipients were included, of whom 42 (12.5%) developed cancer after a median of 6.3 years. In univariable analysis, older age at HTx, smoking history, alcohol use, male sex, ischemic heart disease before HTx, use of cyclosporine rather than tacrolimus, and increased length of follow‐up were associated with cancer. Upon multivariable analysis, ischemic heart disease (OR 2.70 [1.19–6.11], p  = 0.017) and length of follow‐up (OR 1.02 [1.00–1.04], p  = 0.007) were independently associated with cancer occurrence. Cox regression revealed a higher risk of mortality among patients with cancer (HR 3.400, [2.026–5.709], p  < 0.001). HTx recipients with prior ischemic cardiomyopathy and a longer survival time after transplant show a higher risk of developing cancer. Cancer significantly impairs post‐transplant survival. 10.1111/ctr.70243 http://creativecommons.org/licenses/by/4.0/
title Conditions Associated With the Onset of Cancer After Heart Transplant: Longitudinal Study in 335 Recipients
topic Clinical Transplantation
url https://onlinelibrary.wiley.com/doi/10.1111/ctr.70243