Past is Not Prologue - Immune Function Assay Results as a Predictor of Malignancy Post-Heart Transplant (HT)

Purpose Malignancy remains a major cause of morbidity and mortality after HT with limited predictors of outcome. Given that development of malignancy (CA) is linked to degree of immunosuppression, we sought to evaluate the incidence of malignancy and its potential correlation with immune function assay (IFA) results pre and post-CA diagnosis in HT. Methods 2100 adult and pediatric OHTs performed at our institution March 1991 and April 2018 were analyzed. Pre-HT CA was correlated with post-HT recurrence or development of new CA. IFA results were assessed at the time of CA diagnosis and 3m/6m/12m prior. Multivariate Cox proportional hazard regression analysis was performed. Results A total of 55 OHT (2.6%) had either pre- (12) or post-OHT (48) malignancy (CA). The majority of patients were male (83.6%, p0.06), Caucasian (72.7%, p=0.0006), and had smoking hx (49.1%, p=0.004). 33% had a family hx of CA. Treated rejection was associated with increased risk of post-Tx CA (p Conclusion Low immune function assay results were not seen prior to diagnosis of CA, as expected, and results demonstrated minimal variability. Further study is warranted to better understand the potential correlation of immune function assay results with development of post-HT malignancy.