Abstract 17101: Outcome of Heart Transplantation in Pediatric Cancer Survivors
Background: Anthracycline induced cardiomyopathy is a well known complication after malignancy treatment and may cause heart failure severe enough to require heart transplantation. This study evaluates the outcome of heart transplantation in children surviving malignancies, many of which received anthracycline.
Methods: Heart transplant recipients were identified using United Network for Organ Sharing (UNOS) database that underwent heart transplant between 1987 and 2010. Their follow-up data including mortality and rate of recurrence of malignancy were compared with all pediatric transplant patients. Data were analyzed using SPSS 17 version. P value< 0.05 was considered as statistically significant.
Results: 7529 pediatric heart transplants were performed between 1987 and 2010, of which 130 patients survived previous malignancy treatment. 50% were male. Mean age at heart transplantation was 12 years. The survival after heart transplant in malignancy survivors was 92.3%, 91.5% and 77.6% at 3 months, 1 year and 5 years post transplant respectively. This survival rate is comparable with overall survival rate after pediatric heart transplant which was 92.8%, 87.4% and 72.3% at 3 months, 1 year and 5 years respectively. 7/130 (5.3%) patients required re-transplantation in malignancy survivors as compared to 557/7529 (7.6%) of all children requiring re-transplantations. There was no significant difference between occurrence of malignancy in patients with and without history of pre-transplant malignancy (12/130(9.2%) vs. 435/7389 (6%), p=0.12). The 12 patients who developed malignancy after transplant included 1 with a recurrence of the pre-transplant malignancy, 4 with de-novo tumors and 7 with lymphatic disease including lymphoma and pos-transplant lympho-proliferative disease.
Conclusion: Post transplant survival is similar in children with and without pre-transplant malignancy. There is no difference in occurrence of malignancy after heart transplant between children with and without history of pre-transplant malignancy. This suggests that heart transplantation is an appropriate therapeutic option in malignancy survivors with end stage heart disease.
- © 2010 by American Heart Association, Inc.