Incidence of Carcinoma in the Native Lung After Single Lung Transplantation

Fernández, Alba María; Poveda, David; Ruiz, Eloisa; Alvarez, Enriqueta; González, Francisco; Moreno-Moreno, Paloma; Salvatierra, A.; Álvarez, Antonio

doi:10.1016/j.transproceed.2021.10.009

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…In recent years, the number of patients with ILD has been increasing, probably reflecting a relative increase in the number of donors and a decrease in the requirement for LT for idiopathic PAH and lymphangioleiomyomatosis in both diseases, for which effective medications have been developed and are widely used. In Japan, we have started experiencing the occurrence of primary lung cancer in the native ILD lung after unilateral LT, similar to other countries ( 37 , 38 ). The change in recipient characteristics may alter the long-term prognosis of LT recipients in the future.…”

Section: Discussionmentioning

confidence: 84%

Patient selection, surgery and perioperative management in lung transplantation in Japan

Konoeda,

Sato

2024

J Thorac Dis

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Lung transplantation (LT) is the final treatment option for end-stage respiratory diseases. The current prognosis of LT recipients in Japan is good, however, the reason for the good prognosis is unclear. In Japan, the waiting time for cadaveric LT is long, which is approximately 900 days on average. A long waiting time affects several aspects of LT. The diseases progress while they await LT in most patients are waiting for LT. Along with the disease progression of the disease, secondary pulmonary hypertension can newly emerge. Some patients suffer from refractory secondary pneumothorax and may receive pleurodesis. Transplant operations can become more difficult, and postoperative management becomes more complicated owing to the disease progression. Thoracic surgeons in Japan have managed the tough difficult situation of LT patients with LT. Possible explanations for how we to maintain a better prognosis in such a situation include sophisticated surgical techniques and ideas, and vigorous postoperative management by thoracic surgeons. Thoracic surgeons are vigorously involved both in operations and in postoperative management in the intensive care unit with or without intensivists in Japan. On the other hand, the long waiting time in Japan and allocation rules with age restriction without considering the severity of patients may have resulted in the selection of recipients to include relatively young recipients, fewer patients with interstitial lung disease and fewer recipients with extracorporeal membrane oxygenation (ECMO) as a bridge to LT. These recipients’ characteristics possibly may have affected the prognosis of LT patients with LT in Japan. There is a chance that a future increase in the number of cadaveric donors in Japan may result in a prognosis close that is similar to the international average if the current waiting time in Japan decreases. We review patient selection, surgery and perioperative management in LT in Japan to address the question of why the current prognosis of LT recipients in Japan is good.

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Section: Discussionmentioning

confidence: 84%

Patient selection, surgery and perioperative management in lung transplantation in Japan

Konoeda,

Sato

2024

J Thorac Dis

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“…In fact, there may be problems with ventilating the patient at the intensive care unit, as most of the perfusion will go to the transplanted lung, in preference to the native lung, leading to ventilation/perfusion mismatch and hyperinflation of the native lung, which may prolong weaning. Infection of the native lung may be more difficult to treat and the risk of cancer in the native lung is increased to 7–10% during follow-up [ 39 , 40 ], which carries a bad prognosis [ 40 , 41 ]. In a recent study encompassing 72 single LTxs for COPD, there was no difference in 30-day survival in patients with or without early native lung complications, although the late survival was significantly worse in the patients who developed late native lung complications (5-year survival 50% versus 80%) [ 42 ].…”

Section: Choice Of Surgical Proceduresmentioning

confidence: 99%

“…Infection of the native lung may be more difficult to treat and the risk of cancer in the native lung is increased to 7-10% during follow-up [39,40], which carries a bad prognosis [40,41]. In a recent study encompassing 72 single LTxs for COPD, there was no difference in 30-day survival in patients with or without early native lung complications, although the late survival was significantly worse in the patients who developed late native lung complications (5-year survival 50% versus 80%) [42].…”

Section: Evaluation and Preparationmentioning

confidence: 99%

Lung transplantation for COPD/pulmonary emphysema

Verleden¹,

Gottlieb

2023

Eur Respir Rev

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COPD and α-1 antitrypsin deficiency emphysema remain one of the major indications for lung transplantation. If all other treatment possibilities are exhausted or not possible (including rehabilitation, oxygen therapy, noninvasive ventilation, lung volume reduction), patients may qualify for lung transplantation. Strict selection criteria are implemented with a lot of relative and absolute contraindications. Because of an ongoing donor shortage, only a minority of endstage COPD patients will finally get transplanted. The procedure may involve a single or a double lung transplantation, dependent on the experience of the centre, the waiting list, the availability of donor lungs and the patient's risk–benefit ratio. In general, the life expectancy as well as the health-related quality of life after lung transplantation for COPD are usually increased, and may be somewhat better after double compared with single lung transplantation. Several specific complications can be encountered, such as the development of solid organ cancer and chronic lung allograft dysfunction, which develops in up to 50% of patients within 5 years of their transplant and has a major impact on long-term survival, because of the current inefficient treatment modalities.

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Influence of De Novo Malignancies on Long-Term Survival after Lung Transplantation

Ruiz,

Moreno,

Gonzalez

et al. 2023

Cancers

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(1) Background: Malignancies are an important cause of mortality after solid organ transplantation. The purpose of this study was to analyze the incidence of malignancies in patients receiving lung transplants (LT) and their influence on patients’ survival. (2) Methods: Review of consecutive LT from 1994 to 2021. Patients with and without malignancies were compared by univariable and multivariable analyses. Survival was compared with Kaplan-Meier and Cox regression analysis. (3) Results: There were 731 LT malignancies developed in 91 patients (12.4%) with related mortality of 47% (n = 43). Native lung cancer, digestive and hematological malignancies were associated with higher lethality. Malignancies were more frequent in males (81%; p = 0.005), transplanted for emphysema (55%; p = 0.003), with cyclosporine-based immunosuppression (58%; p < 0.001), and receiving single LT (65%; p = 0.011). Survival was worse in patients with malignancies (overall) and with native lung cancer. Risk factors for mortality were cyclosporine-based immunosuppression (OR 1.8; 95%CI: 1.3–2.4; p < 0.001) and de novo lung cancer (OR 2.6; 95%CI: 1.5–4.4; p < 0.001). (4) Conclusions: Malignancies are an important source of morbidity and mortality following lung transplantation that should not be neglected. Patients undergoing single LT for emphysema are especially at higher risk of mortality due to lung cancer in the native lung.

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Incidence of Carcinoma in the Native Lung After Single Lung Transplantation

Cited by 3 publications

References 5 publications

Patient selection, surgery and perioperative management in lung transplantation in Japan

Patient selection, surgery and perioperative management in lung transplantation in Japan

Lung transplantation for COPD/pulmonary emphysema

Influence of De Novo Malignancies on Long-Term Survival after Lung Transplantation

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