Comparison of the Incidence of De Novo Solid Malignancies After Heart Transplantation to That in the General Population

An increased incidence of lymphomas and skin cancers has been shown in heart transplant recipients compared with the general population. However, the incidence of de novo solid tumors in heart transplant recipients has not been compared with the general population. Accordingly, 851 consecutive adult heart transplant recipients at a single large center were followed up from January 1, 1994, to May 31, 2007, to determine the incidence and type of de novo solid-tumor malignancies. The observed incidence of each cancer type was compared with the expected incidence from the Surveillance Epidemiology End Result database, matching for age, gender, and race. Observed counts divided by expected counts yielded a standardized incidence ratio (SIR), which was tested for significance. Of 851 patients, 73 (8.6%) developed de novo solid-tumor malignancies. Sixty men (83.3%) and 12 women (16.7%) aged 58 ± 8 years at transplantation were given a diagnosis of cancer at age 62 ± 8 years. Cancers were divided into 22 categories, and the 3 most frequent cancers were prostate (22), lung (8), and breast (6). SIRs were increased for cervical cancer (SIR 14.3, 95% confidence interval 1.7 to 51.5) and thyroid cancer (SIR 7.7, 95% confidence interval 1.6 to 22.5). Logistic regression showed that age and retransplantation were significant risk factors for cancer. In conclusion, heart transplant recipients did not have a significantly increased frequency of many common malignancies despite long-term immunosuppression.