Cardiac Transplantation for Cancer Involving the Heart: Results from 35 Years of Transplants from the ISHLT Registry

Purpose Cancer of the heart is rare but lethal. For those few patients with primary or metastatic cardiac malignancy, options for treatment are limited. Heart transplantation as a treatment for cardiac malignancy has been suggested by several small case series but outcomes data are scarce. We present a series of 104 heart transplants performed for any cancer involving the heart from 1982 to 2017 from the International Society of Heart and Lung Transplant (ISHLT) Thoracic Organ Transplant Registry. Methods 104 heart recipients were identified with cancer as the indication for transplant. We performed Kaplan-Meier survival analyses matching the 104 cancer patients with 104 patients receiving heart transplants for hypertrophic cardiomyopathy (HCM) because both cohorts are young with few co-morbidities. Matching was based on age, gender and transplant year. Results Median survival in the cancer cohort was 3.6 years (95% Confidence Interval (CI) = 1.2,7.2) compared to 17.5 (CI 16.6, 19.0) years in the matched HCM group (Table). Mortality was not significantly different at 30 days, but at the end of 5 years, more than half of the cancer patients were dead (Figure). 27 of these deaths were due to cancer. In the Cox-proportional hazards model, transplant for cardiac malignancy correlated with mortality (HR=1.8 (CI=1.1-3.1), p=0.02). Conclusion This study presents the largest retrospective series to date of heart transplantations performed for cancer. These patients had significantly increased mortality due to tumor recurrence. This raises a concern about allocating donor hearts for malignancy.