Lung cancer in recipients after lung transplant: single-centre experience and literature review

Abstract

IntroductionLung cancer is a major challenge facing modern medicine. It is the leading cause of cancer-related death in the USA. Little is known of the incidence, prevalence and disease characteristics in lung transplant recipients, a population unique in its vulnerability and exposure to carcinogenic risk factors. We aimed to elaborate these characteristics of lung cancer in our population through a retrospective cohort study.MethodsWe retrospectively reviewed our institution’s 8-year experience with lung transplantation and searched for patients with a post-transplant diagnosis of lung cancer, neoplasia or mass. We focused on patient demographics, indication for transplant, smoking history, stage at diagnosis, location of the tumour, length of time between transplant and diagnosis, the treatment offered and length of time from diagnosis to death or last follow-up. Descriptive statistics and survival analysis standard Kaplan-Meier method was conducted from the date of cancer diagnosis to death from all-cause mortality or last follow-up as of August 2021.ResultsWe identified 24 patients with de novo lung cancer postlung transplant in 905 recipients. More patients with an underlying diagnosis of idiopathic pulmonary fibrosis developed lung cancer. Twenty-one patients were diagnosed with non-small cell lung cancer and three had small cell lung cancer. The remaining native lung was involved most in single lung recipients with 17 patients. Patients with a diagnosis of lung cancer had a mean survival of 17.6 months after diagnosis.DiscussionThe incidence rate of lung cancer in our cohort was higher than reported for smokers from the general population in previous studies. In this study, we compare our findings with available literature. We also explore screening strategies, treatment modalities, survival and postulated mechanisms for the development of lung cancer in lung transplant recipients.

Primary lung adenocarcinoma in transplanted lung in post bilateral lung transplantation

“…Though in our case report, this lady clearly had no history of present or past smoking in any form. In a retrospective study that included posts‐lung transplant patients in Philadelphia, USA, during a period of 8 years, it was found that the mean time from lung transplant to the diagnosis of lung cancer was 24.2 months 6 . There is no reported incidence of developing lung cancer after a prolonged period of 17 years, as in our case report.…”

Lung Cancer in Lung Transplant Recipients: Clinical, Radiologic, and Pathologic Characteristics and Treatment Outcome

“…Another patient developed ARDS after radiation pneumonitis from chemoradiotherapy. Although the number of patients is small, 2 of 12 treated patients (17%) developed posttreatment ARDS, indicating a challenging treatment course of posttransplant lung cancer, which needs increased awareness for close clinical monitoring and imaging assessment after therapy 18 …”

“…11,12 Most of the patients with posttransplant lung cancer in the present study had smoking history (85%), IPF as underlying lung disease (47%), tumors in the native lung (80%), and histology of squamous cell carcinoma followed by adenocarcinoma (40% and 33%, respectively), which were similar to the previous studies. 11,12,17,18 The high incidence of squamous cell carcinoma in the native fibrotic lung may be explained by local inflammations resulting in the increased probability of squamous metaplasia in the fibrotic area. 19,20 No clinical characteristics except for SLTx were associated with the development of posttransplant lung cancer in the present study, which may be due to the cohort size.…”

Lung transplantation for COPD/pulmonary emphysema

“…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 ].…”

“…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].…”