Influence of chronic kidney disease and other risk factors pre-heart transplantation on malignancy incidence post-heart transplantation.

Autor:	Roest S; Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.; Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Gürgöze MT; Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Cherikh WS; United Network for Organ Sharing, Richmond, VA, United States., Stehlik J; Division of Cardiovascular Medicine, U.T.A.H. Cardiac Transplant Program, University of Utah Health Salt Lake City, Utah, UT, United States., Boersma EH; Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Zijlstra F; Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Manintveld OC; Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.; Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2023 Apr 03; Vol. 10, pp. 1145996. Date of Electronic Publication: 2023 Apr 03 (Print Publication: 2023).
DOI:	10.3389/fcvm.2023.1145996
Abstrakt:	Aims: Chronic kidney disease (CKD) pre-heart transplantation (HTx) has been proposed as a risk factor for malignancy risk post-HTx. Using multicenter registry data, our aim was to calculate the death-adjusted annual incidence of malignancies post-HTx, corroborate the association between CKD pre-HTx and malignancy risk post-HTx, and determine other risk factors for post-HTx malignancies. Methods and Materials: We used data from patients transplanted in North American HTx centers between January 2000 and June 2017 and registered in the International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry. We excluded recipients with missing data on post-HTx malignancies, heterotopic heart transplant, retransplantation, multi-organ transplantation, and patients with a total artificial heart pre-HTx. Results: Overall, 34,873 patients were included to determine the annual incidence of malignancies, 33,345 patients were included in the risk analyses. The incidence of any malignancy, solid-organ malignancy, post-transplant lymphoproliferative disease (PTLD), and skin cancer adjusted for death 15 years post-HTx, was 26.6%, 10.9%, 3.6%, and 15.8% respectively. Besides widely acknowledged risk factors, CKD stage ≥4 pre-HTx was associated with the development of all malignancies post-HTx (HR 1.17 compared to CKD stage 1, p  = 0.023), as well as solid-organ malignancies (HR 1.35, p  = 0.01), but not for PTLD (HR 0.73, p  = 0.057), and skin cancer (HR 1.06, p  = 0.59). Conclusion: Risk of malignancy post-HTx remains high. CKD stages ≥4 pre-HTx was associated with an increased risk for any malignancy and solid-organ malignancy post-HTx. Strategies to mitigate the impact of pre-HTx patient factors on the risk of post-HTx malignancy are needed. Competing Interests: WS has received a grant from the Erasmus MC to conduct the analysis for this study. JS has received research funding from Natera and consulting fees from Natera, Medtronic and Sanofi all not related to this work. OM has received fees for Advisory board meetings of Astra Zeneca, Boehringer Ingelheim and Novartis not related to this work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2023 Roest, Gürgöze, Cherikh, Stehlik, Boersma, Zijlstra and Manintveld.)
Databáze:	MEDLINE
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