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Purpose of Review <p>The purpose of this review is to evaluate orthotopic heart transplantation (OHT) in patients with prior/pre-transplant malignancy (PTM).</p> Recent Findings <p>Patients with PTM who receive OHT have increased risk of both recurrent and de novo malignancy, but similar medium and long-term mortality compared to patients without PTM. Those with prior hematologic malignancies and adult congenital heart disease are at a particularly increased risk. Those who have had prior chest radiation pose an additional surgical risk and may have limitations in what mechanical circulatory support is available to them.</p> Opinion Statement <p>Heart transplantation should be an considered as an option for appropriately selected patients with prior/pre-transplant malignancy (PTM) and end-stage heart failure (HF) whether the etiology of HF is cancer therapy-related or not. In the current era, there has been an increasing trend of transplanting patients with prior malignancies, and selection of appropriate patients should be done within the context of a multidisciplinary team with significant input from oncology. Several factors should be considered including type and proximity of prior malignancy, oncologic prognosis, the presence of metastases/stage of malignancy, and response to cancer therapeutics. Due to the risk of both recurrent and de novo malignancy after transplantation, these patients require a tailored approach to frequency and type of pre- and post-OHT screening for malignancy (including increased skin cancer screening) as well as tailored immunosuppression post-transplant. Besides just considering prior malignancy, there are also many related risk factors unique to this patient population that must be considered, such as the proper risk stratification of patients with hematologic malignancies and congenital heart disease (CHD), and exposure to thoracic radiation and the potential consequence of restrictive cardiomyopathies and the challenges this raises when considering a patient for advanced therapies.</p>

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Challenges in Consideration and Management of Orthotopic Heart Transplant in Patients with Cancer

  • 期刊论文

  • 发表日期：

    2026年1月2日

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  • Stephanie Golob,
  • Sophia Zhou,
  • Michelle Bloom

摘要

Purpose of Review

The purpose of this review is to evaluate orthotopic heart transplantation (OHT) in patients with prior/pre-transplant malignancy (PTM).

Recent Findings

Patients with PTM who receive OHT have increased risk of both recurrent and de novo malignancy, but similar medium and long-term mortality compared to patients without PTM. Those with prior hematologic malignancies and adult congenital heart disease are at a particularly increased risk. Those who have had prior chest radiation pose an additional surgical risk and may have limitations in what mechanical circulatory support is available to them.

Opinion Statement

Heart transplantation should be an considered as an option for appropriately selected patients with prior/pre-transplant malignancy (PTM) and end-stage heart failure (HF) whether the etiology of HF is cancer therapy-related or not. In the current era, there has been an increasing trend of transplanting patients with prior malignancies, and selection of appropriate patients should be done within the context of a multidisciplinary team with significant input from oncology. Several factors should be considered including type and proximity of prior malignancy, oncologic prognosis, the presence of metastases/stage of malignancy, and response to cancer therapeutics. Due to the risk of both recurrent and de novo malignancy after transplantation, these patients require a tailored approach to frequency and type of pre- and post-OHT screening for malignancy (including increased skin cancer screening) as well as tailored immunosuppression post-transplant. Besides just considering prior malignancy, there are also many related risk factors unique to this patient population that must be considered, such as the proper risk stratification of patients with hematologic malignancies and congenital heart disease (CHD), and exposure to thoracic radiation and the potential consequence of restrictive cardiomyopathies and the challenges this raises when considering a patient for advanced therapies.