Abstract: Male patients are at increased risk for developing malignancy posthearttransplantation (HT); however, real incidence and prognosis in both gen-ders remain unknown. The aim of this study was to assess differences inincidence and mortality related to malignancy between genders in a largecohort of HT patients. Incidence and mortality rates were calculated for alltumors, skin cancers (SCs), lymphoma, and nonskin solid cancers (NSSCs)as well as survival since first diagnosis of neoplasia. 5865 patients (81.6%male) were included. Total incidence rates for all tumors, SCs, and NSSCswere lower in females [all tumors: 25.7 vs. 44.8 per 1000 person-years; rateratio (RR) 0.68, (0.60?0.78),P<0.001]. Mortality rates were also lower infemales for all tumors [94.0 (77.3?114.3) vs. 129.6 (120.9?138.9) per 1000person-years; RR 0.76, (0.62?0.94),P=0.01] and for NSSCs [125.0(95.2?164.0) vs 234.7 (214.0?257.5) per 1000 person-years; RR 0.60(0.44?0.80),P=0.001], albeit not for SCs or lymphoma. Female sex wasassociated with a better survival after diagnosis of malignancy [log-rank ptest=0.0037; HR 0.74 (0.60?0.91),P=0.004]. In conclusion, incidence ofmalignancies post-HT is higher in males than in females, especially for SCsand NSSCs. Prognosis after cancer diagnosis is also worse in males.

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