{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T09:18:22Z","timestamp":1773047902284,"version":"3.50.1"},"reference-count":43,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,12,4]],"date-time":"2021-12-04T00:00:00Z","timestamp":1638576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"German Heart Foundation\/German Foundation of Heart Research","award":["Rasmus Rivinius"],"award-info":[{"award-number":["Rasmus Rivinius"]}]},{"name":"Physician-Scientist-Program of the Faculty of Medicine, University of Heidelber","award":["Fabrice Darche and Rasmus Rivinius"],"award-info":[{"award-number":["Fabrice Darche and Rasmus Rivinius"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Long-term survival after heart transplantation (HTX) is impacted by adverse effects of immunosuppressive pharmacotherapy, and post-transplant lung cancer is a common occurrence. This study aimed to examine the risk factors, treatment, and prognosis of patients with post-transplant lung cancer. We included 625 adult patients who received HTX at Heidelberg Heart Center between 1989 and 2018. Patients were stratified by diagnosis and staging of lung cancer after HTX. Analysis comprised donor and recipient characteristics, medications including immunosuppressive drugs, and survival after diagnosis of lung cancer. A total of 41 patients (6.6%) were diagnosed with lung cancer after HTX, 13 patients received curative care and 28 patients had palliative care. Mean time from HTX until diagnosis of lung cancer was 8.6 \u00b1 4.0 years and 1.8 \u00b1 2.7 years from diagnosis of lung cancer until last follow-up. Twenty-four patients (58.5%) were switched to an mTOR-inhibitor after diagnosis of lung cancer. Multivariate analysis showed recipient age (HR: 1.05; CI: 1.01\u20131.10; p = 0.02), COPD (HR: 3.72; CI: 1.88\u20137.37; p &lt; 0.01), and history of smoking (HR: 20.39; CI: 2.73\u2013152.13; p &lt; 0.01) as risk factors for post-transplant lung cancer. Patients in stages I and II had a significantly better 1-year (100.0% versus 3.6%), 2-year (69.2% versus 0.0%), and 5-year survival (53.8% versus 0.0%) than patients in stages III and IV (p &lt; 0.01). Given the poor prognosis of late-stage post-transplant lung cancer, routine reassessment of current smoking status, providing smoking cessation support, and intensified lung cancer screening in high-risk HTX recipients are advisable.<\/jats:p>","DOI":"10.3390\/life11121344","type":"journal-article","created":{"date-parts":[[2021,12,5]],"date-time":"2021-12-05T21:01:45Z","timestamp":1638738105000},"page":"1344","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Risk Factors, Treatment and Prognosis of Patients with Lung Cancer after Heart Transplantation"],"prefix":"10.3390","volume":"11","author":[{"given":"Karsten M.","family":"Heil","sequence":"first","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Helmschrott","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4896-9219","authenticated-orcid":false,"given":"Fabrice F.","family":"Darche","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg\/Mannheim, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Bruckner","sequence":"additional","affiliation":[{"name":"Institute for Medical Biometry, University of Heidelberg, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Ehlermann","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg\/Mannheim, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael M.","family":"Kreusser","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg\/Mannheim, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas O.","family":"Doesch","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"Department of Pneumology and Oncology, Asklepios Hospital, 36433 Bad Salzungen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wiebke","family":"Sommer","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregor","family":"Warnecke","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norbert","family":"Frey","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg\/Mannheim, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1146-6319","authenticated-orcid":false,"given":"Rasmus","family":"Rivinius","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, 69120 Heidelberg, Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg\/Mannheim, 69120 Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"i38","DOI":"10.1093\/ejcts\/ezz107","article-title":"Does the heart transplant have a future?","volume":"55","author":"Fuchs","year":"2019","journal-title":"Eur. J. Cardiothorac Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1111\/ajt.16492","article-title":"OPTN\/SRTR 2019 Annual Data Report: Heart","volume":"21","author":"Colvin","year":"2021","journal-title":"Am. J. Transplant."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1056\/NEJMp068048","article-title":"Taking heart-cardiac transplantation past, present, and future","volume":"355","author":"Hunt","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1161\/CIRCULATIONAHA.117.029753","article-title":"Honoring 50 Years of Clinical Heart Transplantation in Circulation: In-Depth State-of-the-Art Review","volume":"137","author":"Stehlik","year":"2018","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Zhu, Y., Lingala, B., Baiocchi, M., Toro Arana, V., Williams, K.M., Shudo, Y., Oyer, P.E., and Woo, Y.J. (2021). The Stanford experience of heart transplantation over five decades. Eur. Heart J., ehab416.","DOI":"10.1093\/eurheartj\/ehab416"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1016\/j.healun.2004.06.009","article-title":"It is time to stop ignoring malignancy in heart transplantation: A call to arms","volume":"24","author":"Hauptman","year":"2005","journal-title":"J. Heart Lung Transplant."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1067\/mtc.2003.168","article-title":"Evolving trends in risk profiles and causes of death after heart transplantation: A ten-year multi-institutional study","volume":"125","author":"Kirklin","year":"2003","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ortega-Legaspi, J.M., and Bravo, P.E. (2021). Diagnosis and management of cardiac allograft vasculopathy. Heart.","DOI":"10.1136\/heartjnl-2020-318063"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S187","DOI":"10.1016\/j.healun.2004.03.009","article-title":"Cardiac allograft vasculopathy after heart transplantation: Risk factors and management","volume":"23","author":"Valantine","year":"2004","journal-title":"J Heart Lung Transplant."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1111\/j.1600-6143.2008.02196.x","article-title":"Malignancy after heart transplantation: Incidence, prognosis and risk factors","volume":"8","author":"Almenar","year":"2008","journal-title":"Am. J Transplant."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3694","DOI":"10.1016\/j.transproceed.2010.07.107","article-title":"Malignancies after heart transplantation: Incidence, risk factors, and effects of calcineurin inhibitor withdrawal","volume":"42","author":"Doesch","year":"2010","journal-title":"Transplant. Proc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1016\/S0041-1345(02)03105-6","article-title":"Malignancy in organ transplantation: Heart","volume":"34","author":"Hunt","year":"2002","journal-title":"Transplant. Proc."},{"key":"ref_14","first-page":"93","article-title":"Analysis of malignancies in patients after heart transplantation with subsequent immunosuppressive therapy","volume":"9","author":"Rivinius","year":"2014","journal-title":"Drug Des. Devel. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1111\/j.1540-8191.2009.00858.x","article-title":"Malignancy after heart transplantation: Analysis of 24-year experience at a single center","volume":"24","author":"Yagdi","year":"2009","journal-title":"J. Card. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.jacc.2017.10.077","article-title":"Temporal Trends of De Novo Malignancy Development After Heart Transplantation","volume":"71","author":"Youn","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1016\/j.healun.2015.05.021","article-title":"Post-transplant lymphoproliferative disease in heart and lung transplantation: Defining risk and prognostic factors","volume":"34","author":"Kumarasinghe","year":"2015","journal-title":"J. Heart Lung Transplant."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.lungcan.2008.04.018","article-title":"Long-term results of lung cancer after heart transplantation: Single center 20-year experience","volume":"63","author":"Bruschi","year":"2009","journal-title":"Lung Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1111\/j.1600-6143.2011.03515.x","article-title":"Lung cancer after heart transplantation: Results from a large multicenter registry","volume":"11","year":"2011","journal-title":"Am. J. Transplant."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2752","DOI":"10.1016\/S0041-1345(00)01867-4","article-title":"Lung cancer in heart transplant patients: A 16-year survey","volume":"32","author":"Dorent","year":"2000","journal-title":"Transplant. Proc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1097\/00007890-199609270-00013","article-title":"Carcinoma of the lung after heart transplantation","volume":"62","author":"Goldstein","year":"1996","journal-title":"Transplantation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1055\/s-2007-965306","article-title":"Long-term survival of heart transplant recipients with lung cancer: The role of chest computed tomography screening","volume":"55","author":"Mohammadi","year":"2007","journal-title":"Thorac Cardiovasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1016\/0003-4975(95)00120-4","article-title":"Solid tumors after heart transplantation: Lethality of lung cancer","volume":"60","author":"Pham","year":"1995","journal-title":"Ann. Thorac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1016\/j.athoracsur.2004.05.021","article-title":"Lung cancer after heart transplantation: A 17-year experience","volume":"79","author":"Potaris","year":"2005","journal-title":"Ann. Thorac. Surg."},{"key":"ref_25","first-page":"12","article-title":"Malignancies After Heart Transplant","volume":"14","author":"Lateef","year":"2016","journal-title":"Exp. Clin. Transplant."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1080\/0284186X.2019.1580385","article-title":"Cancer incidence and mortality after heart transplantation\u2014A population-based national cohort study","volume":"58","author":"Salmela","year":"2019","journal-title":"Acta Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.athoracsur.2004.07.037","article-title":"Immediate and long-term survival after surgery for lung cancer in heart transplant recipients","volume":"79","author":"Bagan","year":"2005","journal-title":"Ann. Thorac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/S1010-7940(97)00114-0","article-title":"Malignant neoplasms following cardiac transplantation","volume":"12","author":"Curtil","year":"1997","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1016\/0003-4975(95)00782-2","article-title":"De novo solid malignancies after cardiac transplantation","volume":"60","author":"Goldstein","year":"1995","journal-title":"Ann. Thorac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.2147\/CLEP.S171929","article-title":"COPD in patients after heart transplantation is associated with a prolonged hospital stay, early posttransplant atrial fibrillation, and impaired posttransplant survival","volume":"10","author":"Rivinius","year":"2018","journal-title":"Clin. Epidemiol."},{"key":"ref_31","first-page":"677","article-title":"Long-term use of amiodarone before heart transplantation significantly reduces early post-transplant atrial fibrillation and is not associated with increased mortality after heart transplantation","volume":"10","author":"Rivinius","year":"2016","journal-title":"Drug Des. Devel. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.2147\/DDDT.S136948","article-title":"Comparison of posttransplant outcomes in patients with no, acute, or chronic amiodarone use before heart transplantation","volume":"11","author":"Rivinius","year":"2017","journal-title":"Drug Des. Devel. Ther."},{"key":"ref_33","first-page":"176","article-title":"Elevated pre-transplant pulmonary vascular resistance is associated with early post-transplant atrial fibrillation and mortality","volume":"7","author":"Rivinius","year":"2020","journal-title":"ESC Heart Fail."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1002\/ehf2.12807","article-title":"Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post-transplant mortality","volume":"7","author":"Rivinius","year":"2020","journal-title":"ESC Heart Fail."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"5440","DOI":"10.21037\/jtd.2019.11.45","article-title":"Risk factors and survival of patients with permanent pacemaker implantation after heart transplantation","volume":"11","author":"Rivinius","year":"2019","journal-title":"J. Thorac. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"4265","DOI":"10.1002\/ehf2.13552","article-title":"Atrial fibrillation before heart transplantation is a risk factor for post-transplant atrial fibrillation and mortality","volume":"8","author":"Darche","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3737","DOI":"10.1002\/ehf2.13494","article-title":"Newly acquired complete right bundle branch block early after heart transplantation is associated with lower survival","volume":"8","author":"Rahm","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Brierley, J., Gospodarowicz, M.K., and Wittekind, C. (2017). TNM Classification of Malignant Tumours, John Wiley & Sons, Inc.. [8th ed.].","DOI":"10.1002\/9780471420194.tnmc26.pub3"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/S0889-8588(18)30250-8","article-title":"Tumors after renal and cardiac transplantation","volume":"7","author":"Penn","year":"1993","journal-title":"Hematol. Oncol. Clin. N. Am."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1056\/NEJMe058018","article-title":"Immunosuppressive drugs and the risk of cancer after organ transplantation","volume":"352","author":"Dantal","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1038\/17401","article-title":"Cyclosporine induces cancer progression by a cell-autonomous mechanism","volume":"397","author":"Hojo","year":"1999","journal-title":"Nature"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1097\/01.TP.0000081399.75231.3B","article-title":"Tacrolimus enhances transforming growth factor-beta1 expression and promotes tumor progression","volume":"76","author":"Maluccio","year":"2003","journal-title":"Transplantation"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.lungcan.2015.10.007","article-title":"Lung cancer survival in Germany: A population-based analysis of 132,612 lung cancer patients","volume":"90","author":"Eberle","year":"2015","journal-title":"Lung Cancer"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/11\/12\/1344\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:39:47Z","timestamp":1760168387000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/11\/12\/1344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,4]]},"references-count":43,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["life11121344"],"URL":"https:\/\/doi.org\/10.3390\/life11121344","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,4]]}}}