The Place of Skin Cancer Screening in Heart Transplant Recipient Follow-Up Protocols: A Case Series

Introduction: Since 2000, suicide rates have dramatically increased, while deaths from motor vehicle accidents (MVAs) have declined. Poisoning has surpassed MVAs as the leading cause of preventable death, largely due to the opioid epidemic. Analyses regarding the forensic pathology of donor death and heart transplant recipient outcomes are lacking. We sought to determine how donor mechanisms (e.g. drug intoxication, asphyxiation) and circumstances (e.g. suicide, MVA) of death have affected heart transplant outcomes over the last 20 years. Methods: The UNOS database was queried for all first-time isolated heart transplants occurring between January 2000 through March 2019. First-time recipients were included. Donor, recipient, and procurement variables were screened by univariable logistic analysis to identify potential independent predictors of survival with freedom from transplantation at 1 year after heart transplant. A final parsimonious multivariable regression model was created, including all causes, mechanisms and circumstances of donor death. The primary endpoint of analysis was survival with freedom from retransplantation at last follow-up. Analyses were conducted for 2000-19, and stratified by decade (2000-09 and 2010-19). Results: 34,373 patients met inclusion criteria. Median follow-up was 4.3 (IQR1.3-8.9) years. From 2000-19, death by suicide has had worse overall survival (HR 1.27; CI 1.1-1.5). A similar association is seen prior to 2010 (HR1.36; CI1.06-1.74). Since 2010, death by asphyxiation has been associated with improved survival (HR0.7; CI0.5-0.9). Death by MVA has become associated with early (i.e. 30-day) mortality (HR1.7; CI1.1-2.7), and worse survival among patients surviving 1-year after transplant. Donor death from drug intoxication has had no significant effect on recipient outcomes in the past 20 years. Conclusions: Since 2010, donors who died by MVA have worse early survival in heart transplant. Death by asphyxiation now appears to have a protective effect on overall survival. Suicide is no longer associated with poorer outcomes. Further study into how public health initiatives, policy, and epidemics effect transplant outcomes may improve donor selection and organ allocation in heart transplantation.

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Post-transplant Lymphoproliferative Disease Presenting as a Mass in the Left Ventricle in a Heart Transplant Recipient at Long-term Follow-up

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2008.11.916 ◽

2009 ◽

Vol 28 (2) ◽

pp. 206-208 ◽

Cited By ~ 6

Author(s):

José H.F. Palma ◽

José C.S. Guilhen ◽

Diego F. Gaia ◽

Andre Teles ◽

Carlos A. Teles ◽

...

Keyword(s):

Left Ventricle ◽

Transplant Recipient ◽

Heart Transplant ◽

Heart Transplant Recipient ◽

Lymphoproliferative Disease ◽

Post Transplant ◽

Long Term Follow Up

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Clinical follow-up of the heart transplant recipient

Current Opinion in Cardiology ◽

10.1097/00001573-199503000-00013 ◽

1995 ◽

Vol 10 (2) ◽

pp. 180-192 ◽

Cited By ~ 7

Author(s):

Maryl R. Johnson

Keyword(s):

Transplant Recipient ◽

Heart Transplant ◽

Heart Transplant Recipient

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Observed and expected mortality in the German skin cancer screening pilot project SCREEN

Journal of Medical Screening ◽

10.1177/0969141317734003 ◽

2017 ◽

Vol 25 (3) ◽

pp. 166-168 ◽

Cited By ~ 4

Author(s):

Nora Eisemann ◽

Annika Waldmann ◽

Bernd Holleczek ◽

Alexander Katalinic

Keyword(s):

Cancer Screening ◽

Skin Cancer ◽

Pilot Project ◽

Mortality Reduction ◽

Skin Cancer Screening ◽

Melanoma Diagnosis ◽

Mortality Ratio ◽

Expected Mortality ◽

Melanoma Mortality

Objective The main purpose of skin cancer screening is melanoma mortality reduction. Before the implementation of nationwide German skin cancer screening, the pilot project SCREEN was conducted in Schleswig-Holstein in 2003–2004. We aimed to determine whether the pilot project had achieved a mortality reduction. Methods Using an incidence-based approach (patients with both melanoma diagnosis and death in 2003–2008), we compared the observed melanoma mortality of the SCREEN cohort to the melanoma mortality expected without screening in the general population of Saarland. Results The age- and sex-standardized melanoma mortality ratio (SMR) for 5.5 years of follow-up was 0.59 (95% confidence interval, 0.40–0.83). Conclusion Our results indicate reduced mortality in the SCREEN cohort. Several potential biases cannot be excluded, but most of them tend to inflate the SMR.

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