Characteristics and outcomes of heart transplantation recipients with a history of malignancy: a nationwide population-based cohort study
J C Youn, J S Kim, M H Jung, E S Kim, S Y Kim, J J Kim, D W Kang, S J Park, H O JungAbstract
Background
Heart transplant (HTx) is a recommended therapy for selected patients with advanced heart failure, but its application in patients with a pre-transplant history of malignancy (PTM) remains a clinical challenge. We aimed to characterize the clinical features, cancer profiles, and time-dependent mortality risks in this growing population.
Methods
We analysed overall and cancer-specific mortality among 1,809 HTx recipients and compared patients with PTM to those without, using the Korean National Health Insurance Service (NHIS) database (2006–2022). Multivariable Cox proportional hazards models and a one-year post-transplant landmark analysis were used to assess temporal risk patterns. We also calculated standardised incidence ratios (SIR) for specific cancer types.
Result
Of 1,809 HTx recipients, 121 (6.7%) had PTM. While overall mortality did not differ significantly across the total follow-up period (aHR 1.27; 95% CI 0.93–1.76), the landmark analysis revealed a distinct temporal shift. Early mortality within one year was comparable between groups (aHR 0.90; 95% CI 0.56–1.44). However, beyond one year, the PTM group faced a significantly higher risk of late-onset mortality (aHR 1.96; 95% CI 1.25–2.98). This late-term risk was primarily driven by a markedly higher incidence of post-transplant cancer (aHR 13.51; 95% CI 9.51–19.17) and cancer-related death (aHR 9.35; 95% CI 4.82–18.14). Specifically, the risk of lymphoma (SIR 21.39) and non-melanoma skin cancer (SIR 17.35) increased substantially.
Conclusion
HTx recipients with PTM demonstrate comparable short-term survival but experience increased late-onset mortality, predominantly due to recurrent or de novo malignancies. These findings underscore the need for rigorous, lifelong oncologic surveillance and personalized immunosuppression strategies for this growing high-risk population.For image description, please refer to the figure legend and surrounding text.