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Risk Factors, Treatment and Prognosis of Patients with Lung Cancer after Heart Transplantation

Authors :
Karsten M. Heil
Matthias Helmschrott
Fabrice F. Darche
Tom Bruckner
Philipp Ehlermann
Michael M. Kreusser
Andreas O. Doesch
Wiebke Sommer
Gregor Warnecke
Norbert Frey
Rasmus Rivinius
Source :
Life, Vol 11, Iss 12, p 1344 (2021)
Publication Year :
2021
Publisher :
MDPI AG, 2021.

Abstract

Long-term survival after heart transplantation (HTX) is impacted by adverse effects of immunosuppressive pharmacotherapy, and post-transplant lung cancer is a common occurrence. This study aimed to examine the risk factors, treatment, and prognosis of patients with post-transplant lung cancer. We included 625 adult patients who received HTX at Heidelberg Heart Center between 1989 and 2018. Patients were stratified by diagnosis and staging of lung cancer after HTX. Analysis comprised donor and recipient characteristics, medications including immunosuppressive drugs, and survival after diagnosis of lung cancer. A total of 41 patients (6.6%) were diagnosed with lung cancer after HTX, 13 patients received curative care and 28 patients had palliative care. Mean time from HTX until diagnosis of lung cancer was 8.6 ± 4.0 years and 1.8 ± 2.7 years from diagnosis of lung cancer until last follow-up. Twenty-four patients (58.5%) were switched to an mTOR-inhibitor after diagnosis of lung cancer. Multivariate analysis showed recipient age (HR: 1.05; CI: 1.01–1.10; p = 0.02), COPD (HR: 3.72; CI: 1.88–7.37; p < 0.01), and history of smoking (HR: 20.39; CI: 2.73–152.13; p < 0.01) as risk factors for post-transplant lung cancer. Patients in stages I and II had a significantly better 1-year (100.0% versus 3.6%), 2-year (69.2% versus 0.0%), and 5-year survival (53.8% versus 0.0%) than patients in stages III and IV (p < 0.01). Given the poor prognosis of late-stage post-transplant lung cancer, routine reassessment of current smoking status, providing smoking cessation support, and intensified lung cancer screening in high-risk HTX recipients are advisable.

Details

Language :
English
ISSN :
20751729
Volume :
11
Issue :
12
Database :
Directory of Open Access Journals
Journal :
Life
Publication Type :
Academic Journal
Accession number :
edsdoj.700110ce490a4443bca1a8c6d51a9169
Document Type :
article
Full Text :
https://doi.org/10.3390/life11121344