Malignancy is still a relevant barrier to long term survival after heart transplantation. Immune monitoring of basic components of the immune response could be a useful tool to identify the risk for development of malignancy. We aimed to identify immunological biomarkers that could be associated with risk of malignancy.
In a prospective follow-up study 265 patients were evaluated in a single center. Mean age was 66,48 years (women 13,04%, men 86,96%). During a long-term follow-up, 69 patients developed at least one new malignancy after heart transplantation. Mean time from transplantation to diagnosis of post transplant malignancy was 4,71 years. A total of 122 malignancies were diagnosed: epithelial (35,2%), mucose (24,6%), metastasis (8,2%). Immunological biomarkers were evaluated at the time of inclusion in waiting list and at 7 and 30 days after heart tranplantation.
One-week after transplantation lower B-cell percentages (<3,13%) and lower B-cell absolute counts (<73,5 cells/uL) were risk factors for development of malignancy. Seven days after-transplantation, patients with IgG hypogammaglobulinemia (IgG<477 mg/dL, p=0,019), absolute NK-cell counts (<72,5/uL, p=0,004) and absolute T CD3+ counts (<208,50/uL) were at higher risk of having metastasis after diagnosis of malignancy during follow-up. Clinical risk factors of malignancy were age> 66 years; smoke; ischemia, chronic inflammatory conditions and infections. Low B-cell counts at 7 days (LB <73,5 cell/uL, OR 6.19, 95% CI 2,25-17,07, p<0,001) were significantly associated with malignancy risk after adjustment by clinical variables.
A profile of distinct immunological abnormalities is associated with a high risk for developing malignancy and metastasis after heart transplantation.