Malignancy After Transplant

An underappreciated but important complication of heart transplantation is the development of post-transplant malignancy. With continued improvements of heart transplant recipient survival, the prominence of these malignancies has been increasingly recognized, leading to more investigation regarding their pathophysiology and impacts on treatment and prognosis. As a result, there is a better understanding of the unique malignancy risks associated with transplant recipients and the effects on clinical outcomes. Although there are a variety of risk factors for malignancy that overlap with non-transplant recipients, immunosuppression plays a unique and significant role in malignancy pathogenesis. Malignancy type varies widely, from virus-associated malignancies such as post-transplant lymphoproliferative disorder to dermatologic malignancies such as non-melanomatous skin cancer. Strategies for prevention, screening, and treatment of these malignancies are continually evolving. This chapter reviews the epidemiology and types of malignancies post-transplant and the role immunosuppression regimens may play toward the development and in treatment of these malignancies.