LAUSR

Introduction Due to chronic immunosuppression, heart transplant recipients are at risk for developing malignancy, compromising long-term survival. A subset of our veteran heart transplant recipients have been exposed to Agent Orange, an herbicide which is linked to the development of hematologic malignancies and soft tissue sarcoma. Hypothesis We hypothesized that Agent Orange exposure would lead to a higher prevalence of post-transplant malignancy and decreased survival. Methods We conducted a retrospective chart review of all 188 heart transplant patients who received their longitudinal care at the William S. Middleton Memorial Veterans Hospital since the program's inception on Oct. 1, 1993. Demographic data were collected for each patient. Proof of Agent Orange exposure was based on VA administrative review of service records. Univariate analysis was conducted to identify variables linked to the incidence of cancer. Multivariate analysis using a Cox Proportional Hazard Model was used to assess the influence of Agent Orange on the development of malignancy and post-transplant survival. Kaplan Meier analyses were used to assess survival and the incidence of cancer, stratified by Agent Orange exposure. Results Of the 188 patients, 113 have died. Malignancy accounted for 28% of the deaths. Fifty three percent of the patients developed malignancy after transplant (n = 100). Seventy seven developed skin cancer (41%), 46 developed solid organ cancer (24%), and 5 developed hematologic cancer (3%). Twenty nine patients were diagnosed with multiple malignancies (15%). Sixteen percent of our patients were exposed to Agent Orange (n=31). Univariate predictors of developing malignancy included older age at time of transplant (p Conclusions Survival and risk for developing solid organ malignancy following heart transplant were not influenced by Agent Orange contact. While the incidence of hematologic malignancy post-transplant was low, Agent Orange exposure may have contributed.