Cancer incidence and mortality after heart transplantation – A population-based national cohort study

Abstract

Background: Cancer is currently one of the most important factors affecting the long-term health and survival of heart transplant patients.

Material and methods: We calculated the standardized incidence ratios (SIR) for different cancer sites and the cancer-specific standardized mortality ratio (SMR) by linking a cohort of 479 adult heart transplant recipients transplanted in 1985–2014 (4491.6 person-years of follow-up) with data from the national Finnish Cancer Registry until the end of 2015, and with the data from the Statistics Finland’s national registry of causes of death.

Results: A total of 267 cancers occurred in 143 patients (SIR 6.0; 95% confidence interval (CI) 5.3–6.7). The SIR for overall cancer was considerably higher for men (SIR 6.7; 95% CI 5.9–7.5) than for women (1.4; 95% CI 0.6–2.6). Most frequent cancers were non-melanoma skin cancers (basal cell carcinoma 83 cases, squamous cell skin cancer (SCC) 56 cases), followed by Non-Hodgkin lymphoma (NHL) (36 cases), lung cancer (17), cancer of prostate (16) and cancer of kidney (12). SIRs were highest for SCC (51.9; 95% CI 39.2–67.4), lip cancer (47.4; 95% CI 19.1–97.7), cancer of tongue (26.3; 95% CI 7.2–67.4), and NHL (25.7; 95% CI 18.0–35.6). For most cancers, SIRs increased steadily by time since transplantation. Cancer mortality was three times higher for heart transplant recipients than for the population (SMR 3.1; 95% CI 2.1–4.1).

Conclusions: Both cancer incidence and mortality are remarkably increased after heart transplantation, with the relative incidence most elevated for SCC, lip and other oral cancers, and for NHL.