Malignancy following Heart Transplantation: Differences in Incidence and Prognosis between Sexes

Male patients are at increased risk for developing malignancy post-heart transplantation (HT); however, real incidence and prognosis in both genders remains unknown. The aim of this study was to assess differences in incidence and mortality related to malignancy between genders in a large cohort of HT patients. Incidence and mortality rates were calculated for all tumors, skin cancers (SCs), lymphoma and non-skin solid cancers (NSSCs) as well as survival since first diagnosis of neoplasia. 5865 patients (81.6% male) were included. Total incidence rates for all tumors, SCs and NSSCs were lower in females (all tumors: 25.7 vs. 44.8 per 1000 person-years; Rate Ratio (RR) 0.68, (0.60-0.78), p\u003c0.001). Mortality rates were also lower in females for all tumors (94.0 (77.3-114.3) vs. 129.6 (120.9-138.9) per 1000 person-years; RR 0.76, (0.62-0.94), p=0.01) and for NSSCs (125.0 (95.2-164.0) vs 234.7 (214.0-257.5) per 1000 person-years; RR 0.60 (0.44-0.80), p=0.001), albeit not for SCs or lymphoma. Female sex was associated to a better survival after diagnosis of malignancy (log-rank p test=0.0037; HR 0.74 (0.60-0.91), p=0.004). In conclusion, incidence of malignancies post-HT is higher in males than in females, especially for SCs and NSSCs. Prognosis after cancer diagnosis is also worse in males.