Key result
Pediatric heart transplant recipients with prior malignancy had similar 10-year survival to those without (65% vs 57.7%), despite higher post-transplant malignancy rates (13% vs 5.4%, p=0.001).
Why the study?
Does heart transplantation provide similar survival in pediatric cancer survivors compared to pediatric patients without prior malignancy?
Cohort (n=7,169)
Yes
Does heart transplantation provide similar survival in pediatric cancer survivors compared to pediatric patients without prior malignancy?
Absolute Event Rate: 65% vs 57.7%
Heart transplantation is a reasonable treatment option for pediatric cancer survivors with end-stage heart disease, offering similar long-term survival to those without prior malignancy despite a higher risk of secondary malignancies.
Supports transplantation for pediatric cancer survivors with end-stage disease; extends limited evidence but remains hypothesis-generating.
The aim of this study is to evaluate the outcome of heart transplantation in children surviving malignancies. Pediatric heart transplant recipients were identified using the UNOS database. Follow-up data including survival and rate of malignancy were analyzed. A total of 7169 children received heart transplants between 1987 and 2011. Of these, 107 (1.5%) survived previous malignancy treatment (group I) and 7062 (98.5%) did not have prior malignancy (group II). Survival after transplant was 92.5%, 90.6%, 80.3%, and 65% at three months, one, five, and 10 yr in group I, similar to the rate in group II (90.1%, 84.4%, 73.8%, and 57.7%). Survival after transplantation was similar between group I and children who underwent OHT secondary to cardiomyopathy in group II. The rate of post-OHT malignancy in group I was higher than that in group II (14/107(13%) vs. 386/7062 (5.4%), p = 0.001). Children who developed malignancy in group I had similar survival as children who developed malignancy in group II. Post-transplant survival is similar in children with and without pretransplant malignancy in spite of higher rate of malignancy in children with pretransplant malignancy. OHT appears to be a reasonable treatment option in children who develop end-stage heart disease after malignancy treatment.
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Shah et al. (2013) conducted a cohort in End-stage heart disease requiring transplantation (n=7,169). Pretransplant malignancy vs. No prior malignancy was evaluated on 10-year survival after transplantation. Pediatric heart transplant recipients with prior malignancy had similar 10-year survival to those without (65% vs 57.7%), despite higher post-transplant malignancy rates (13% vs 5.4%, p=0.001).
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