Low incidence of neoplasia in heart and heart-lung transplant recipients receiving triple-drug immunosuppression

The risk of neoplasias developing after solid organ transplantation is markedly increased by immunosuppressive therapy. Lymphoma has been reported to develop in 13% of heart and in 33% of heart-lung transplant recipients treated with cyclosporine, and the incidence of skin carcinoma ranges between 6% and 16%. The incidence of posttransplant neoplasias with the use of lower loading and maintenance doses of cyclosporine as used in triple-drug immunosuppression is unknown. From December 1983 through August 1988, 134 heart and seven heart-lung transplants were performed at the University of Minnesota. All patients received a combination of cyclosporine, azathioprine, and prednisone. Survival was 94% at 1 and 90% at 3 years in heart recipients. Probability of acute rejection was 9% at 3 months and 12% at 1 and 3 years. B-cell lymphoma developed after heart transplant in only two patients for an incidence of 1.5%. Episodes of acute rejection and mean cyclosporine blood level did not predict the occurrence of posttransplant lymphoma. The incidence of skin carcinoma was 6.4%. No neoplasia occurred in heart-lung transplant recipients. All neoplasias were observed in patients older than 50 years. Our data indicate that the risk for developing lymphoproliferative disorders, but not for basal cell carcinoma, is reduced in heart and heart-lung transplant recipients receiving triple-drug immunosuppression. Older recipients may be at increased risk, suggesting that lower doses of immunosuppressive therapy should be considered in this group.