Malignant neoplasms in the long term after orthotopic heart transplantation
Abstract The analysis of 29 patients with dilated cardiomyopathy syndrome and ischemic cardiomyopathy (5 women and 24 men; mean age was 44.7±3.2 years), which between 1990 and 2015 at the Petrovsky Russian Research Center of Surgery was performed orthotopic heart transplantation. Medical history of the disease has averaged 5.7±1.4 years. The clinical status of all recipients consistent with IV NYHA. Average end-diastolic left ventricular size was 7.7±0.51 sm, ejection fraction – 11.9±0.35%, the mean pulmonary artery pressure 65.8±7.9 mm Hg. Hospital mortality was 20.7%. Survival to 5th year after surgery was 75%, the 10th year – 45%. One of the main causes of mortality in the long term were malignant neoplasms. These data indicate that orthotopic heart transplantation gives patients with dilated cardiomyopathy syndrome and end-stage heart failure chance for long-term active life. However, this forecast is in direct proportion to the emergence of several complications, including progression of malignant tumors, trigger the development of which is probably active immunosuppressive therapy. It is therefore necessary to develop efficient algorithms for monitoring risk for the development of malignant tumors with the aim of improving long-term results of cardiac transplantation.
Keywords:chronic heart failure, orthotopic heart transplantation, immunosupressivе therapy, malignant neoplasms
Clin. Experiment. Surg. Petrovsky J. 2016. № 1. Р. 6–10.
References
1. Moysyuk J.G., Pogrebnichko I.V., Kornilov M.N., Sushkov A.I., Gautier S.V. Transplantation of the liver. A 10-year retrospective. Transplantologiya [Transplantation]. Vol. 3. 2015: 17–19.
2. Dzemeshkevich S.L., Tsyplenkova V.G., Frolova J.V., Voronina T.S., Oettinger A.P. Post-transplant cardiomyopathy: energy apparatus of cardiomyocytes in terms up to 25 years after orthotopic heart transplantation. Rossiyskiy kardiologicheskiy zhurnal [Russian Journal of Cardiology]. 2015; Vol. 11 (127): 42-45.
3. Almenar L., Segovia J., Crespo-Leiro M.G., Palomo J., Arizo’n J.M., Go’ nzalez-Vi’lchez F, et al. Registro Espan’ol de Trasplante Cardiaco. XXIII Informe Oficial de la Seccio’n de Insuficiencia Cardiaca y Trasplante Cardiaco de la Sociedad Espan’ola de Cardiologi’a (1984–2011). Rev Esp Cardiol. 2012; Vol. 65: 1030–8.
4. Bolman R.M.III, Elick B., Olivari M.T., et al. Improved immunosupression for heart transplantation. J. Heart Transplant. 1985; Vol. 4: 315.
5. Bruschi G., Colombo T., Oliva F., Botta L., et al. Heart transplantation: 25 years' single-centre experience. J Cardiovasc Med (Hagerstown). 2013; Vol. 14 (9): 637–47.
6. Clemmensen T.S., Munk K., Tram E.M., Ilkjaer L.B., Severin- sen I.K., Eiskjaer H. Twenty years' experience at the Heart Transplant Center, Aarhus University Hospital, Skejby, Denmark. Scand Cardiovasc J. 2013; Vol. 47 (6): 322–8.
7. Doesch A.O., Muller S., Konstandin M., et al. Malignancies after heart transplantation: incidence, risk factors, and effects of calcineurin inhibitor withdrawal. Transplant Proc. 2010; Vol. 42 (9): 3694–9.
8. Lund L.H., Edwards L.B., Kucheryavaya A.Y., et al. International Society for Heart and Lung Transplantation International Society for Heart and Lung Transplantation. The Registry of the International Society for Heart and Lung Transplantation: thirtieth official adult heart transplant report-2013; focus theme: age. J Heart Lung Transplant. 2013; Vol. 32 (10): 951–64.