What Is the Effect of Pre-Transplant Malignancy on the Outcome After Heart Transplantation? A Systematic Review

Introduction: The number of cancer survivors increases steadily over time because of improved cancer treatment. The number of survivors needing heart transplantation is also rising. This review addresses the post-transplant survival and cancer incidence of patients with a pretransplant malignancy. Methods: A literature search was performed for the last 10 years using the search terms: (heart OR cardiac) AND pretransplant* AND malignancy. Only full articles were included and assessed by the Newcastle-Ottawa Scale of their quality. Results: Nine manuscripts were identified, of which seven were of good quality. Only in four series, patients undergoing heart transplantation were analyzed separately from other solid organ transplants. The outcomes were survival, cancer specific survival, cancer recurrence and skin cancer specifically. Four series were single center based, the other five were region or nationwide surveys. Also, four series included only heart transplant patients. The outcome varied, but most series showed a significant increase in decreased survival and incidence of post-transplant malignancy if a pretransplant malignancy was present. Age, male gender and a fair skin were other risk factors, especially for post-transplant skin cancer. However, for patients with pretransplant malignancy, survival was acceptable. Conclusion: Pretransplant malignancy does not preclude heart transplantation. However, the time interval between pretransplant malignancy and heart transplantation, as well as the nature of malignancy should be considered. The research for the outcome after heart transplantation in these patients has serious limitations.