Nádorová onemocnění u pacientů po transplantaci srdce

Cor Vasa 2002, 43(2):77-80

Malignancies in patients after heart transplantation

Lenka Hošková^1,*, Ivan Málek¹, Mariana Podzimková¹, Vladimír Staněk¹, Jan Pirk², Martin Kment³: ¹ Klinika kardiologie; ² Klinika kardiovaskulární chirurgie; ³ Patologicko-anatomické pracoviště, Institut klinické a experimentální medicíny, Praha, Česká republika

Introduction:
Malignancies occur 4-7 times more often in patients after heart transplantation than in the general population and tend to progress more rapidly. Long-term immunosuppressive therapy and recurrent infections make the immune system less capable of destroying potentially malignant cells. The study was designed to determine the incidence of tumors at different time intervals post-transplant and the pattern of tumor distribution.

Methods:
From 1984 through December 2000, a total of 419 heart transplant procedures (371 in men and 48 in women) were performed at the Institute for Clinical and Experimental Medicine. The underlying disease was cardiomyopathy in 52%, and coronary heart disease in 42%. After transplantation, patients were on regular three-month follow-up (the interval was shorter during the first year). Diagnosis of a malignancy was established on the basis of clinical symptoms, laboratory abnormalities, and using imaging techniques. All patients with tumors had their immunosuppressive regimen adjusted accordingly.

Results:
A tumor was identified in 28 patients, i.e., 6.7% of the total. The tumor could be removed by surgery in 21 patients, with 7 treated by chemotherapy or radiation therapy. The mean interval from the development of a tumor to transplantation was 3.8 years (3 months to 10 years). The survival rates from diagnosis ranged from 1 months to 7 years. Ten patients (36%) died. The most frequent malignancies included tumors of the skin, digestive tract, lungs, and lymphoproliferative disease.

Conclusion:
Prevention and early diagnosis of a potential tumor make an integral part of care of patients undergoing heart transplantation. Patients with tumors more amenable to surgery had a relatively better prognosis.