Incidence of malignancies in heart and/or lung transplant recipients: a single-institution experience.

BACKGROUND: The purpose of this study was to determine the incidence and type of malignancies in heart and/or lung transplant recipients at a single institution in Victoria, Australia, and to compare these findings with the non-transplant general Victorian population. METHODS: Recipients of heart and/or lung transplants at the Alfred Hospital between February 1989 and January 2004 were cross-referenced with the Victorian Cancer Registry. The medical records of all patients with a cancer diagnosis by January 1, 2005 were reviewed. Data were collected on baseline demographics, including cancer type, stage, treatment and survival. Cancer incidence was then compared with rates found in the Victorian population. RESULTS: There were 907 transplants (Tx) conducted between February 1989 and January 1, 2004 on 905 patients, which included 424 heart (HTx), 56 heart-lung (HLTx), 200 single-lung (SLTx), and 227 double-lung (DLTx) procedures. Of these patients, 606 (67%) were male and 299 (33%) were female. Mean age at transplantation was 46.4 years (range 12.6 to 70.4 years). Four hundred twenty-four (47%) deaths have occurred. Median survival for all patients after transplantation was 8.6 years. One hundred two cancers were confirmed, translating to a 7.1-fold increased incidence compared with the non-transplant population. The most common cancer diagnoses were lymphoproliferative disorders (692 per 100,000 person-years), head and neck cancer (336 per 100,000 person-years) and lung cancer (251 per 100,000 person-years). Compared with the non-transplant population this translates into a 26.2-, 21.0- and 9.3-fold increased risk for developing these cancers, respectively, after cardio-pulmonary transplantation. CONCLUSIONS: Certain malignancies are more common after heart and/or lung transplantation. The most predominant in our cohort were lymphoproliferative disorders, head and neck cancer and lung cancer.

Achieving equal standards in medical student education: is a national exit examination the answer?

Although it is commonly assumed that the quality of medical school education in Australia is uniformly high, there is no national process for assessing its outcomes. There is substantial variability in the content of medical school curricula, and the process of curriculum change is becoming more challenging because of intense competition for time and space in the course. A national exit examination could provide a uniform standard of assessment for all medical school graduates in Australia, as well as foreign graduates applying to work in Australia. Such an examination could assess medical school outcomes, monitor the effects of curriculum change, and provide a benchmark for new medical schools that would help medical curricula evolve to better meet society's needs.