Malignancy after Heart Transplantation under Everolimus Versus Mycophenolate Mofetil Immunosuppression
Journal
Transplantation Proceedings
Journal Volume
48
Journal Issue
3
Pages
969-973
Date Issued
2016
Author(s)
Wang Y.-J.
Tsao C.-I.
Tsai J.-T.
Abstract
Background: With advances in immunosuppressive therapy, heart transplantation is currently recommended as the only established surgical treatment for refractory heart failure. However, chronic immunosuppression increases the risk for malignancy. Everolimus (EVR) is a potent mammalian target of rapamycin inhibitor that is used after transplantation and to treat advanced malignancies, as we have done in Taiwan after heart transplantation since 2004. Mycophenolate mofetil (MMF) and EVR are frequently used as cell-cycle inhibitors to optimize post-transplantation outcomes.
Methods: We retrospectively analyzed the characteristics and outcomes of 454 patients who received either MMF (n = 232) or EVR (n = 222) after heart transplantation at the National Taiwan University Hospital from March 1, 1990, to March 1, 2015. Patient characteristics and Kaplan-Meier survival curves were compared between groups.
Results: During a median follow-up of 69.2 months, malignancy was diagnosed in 27 patients receiving MMF (n = 23) or EVR (n = 4). There was a significant difference in malignancy risk between groups (9.91% vs 1.80%, P = .001). The most common malignancies were non-Hodgkin lymphoma, skin cancers, and lung squamous cell carcinoma. The 2-year overall survival after malignancy was 50% in the EVR group and 47% in the MMF group (P = .745).
Conclusions: EVR treatment after heart transplant is associated with a lower risk of malignancy than is MMF treatment. The 2-year survival rate after malignancy was similar between EVR and MMF groups.
SDGs
Other Subjects
everolimus; mycophenolate mofetil; everolimus; immunosuppressive agent; mycophenolic acid; adolescent; adult; aged; Article; cancer risk; cancer survival; cardiac graft rejection; female; follow up; heart transplantation; human; immunosuppressive treatment; infant; major clinical study; male; malignant neoplastic disease; nonhodgkin lymphoma; outcome assessment; overall survival; priority journal; retrospective study; skin cancer; squamous cell lung carcinoma; university hospital; adverse effects; animal; chemically induced; child; heart transplantation; immunosuppressive treatment; incidence; Kaplan Meier method; Lymphoma, Non-Hodgkin; middle aged; Postoperative Complications; preschool child; Skin Neoplasms; survival rate; Taiwan; trends; young adult; Adolescent; Adult; Aged; Animals; Child; Child, Preschool; Everolimus; Female; Follow-Up Studies; Heart Transplantation; Humans; Immunosuppression; Immunosuppressive Agents; Incidence; Infant; Kaplan-Meier Estimate; Lymphoma, Non-Hodgkin; Male; Middle Aged; Mycophenolic Acid; Postoperative Complications; Retrospective Studies; Skin Neoplasms; Survival Rate; Taiwan; Young Adult
Publisher
Elsevier USA
Type
journal article