Malignancy after lung transplantation

Abstract

Lung transplantation is an established therapeutic option for selected patients with advanced lung diseases. As early outcomes after lung transplantation have improved, chronic medical illnesses have emerged as significant obstacles to long-term survival. Among them is post-transplant malignancy, currently representing the 2 nd most common cause of death 5-10 years after transplantation. Chronic immunosuppressive therapy and resulting impairment of anti-tumor immune surveillance is thought to have a central role in cancer development after solid organ transplantation (SOT). Lung transplant recipients receive more immunosuppression than other SOT populations, likely contributing to even higher risk of cancer among this group. The most common cancers in lung transplant recipients are non-melanoma skin cancers, followed by lung cancer and post-transplant lymphoproliferative disorder (PTLD). The purpose of this review is to outline the common malignancies following lung transplant, their risk factors, prognosis and current means for both prevention and treatment.

Characteristics and clinical implications of pleural effusions after lung transplantation: A retrospective analysis of 195 thoracocenteses in 113 patients

“…Lung‐transplant recipients are at increased risk of malignancy due to long‐term immunosuppression 21 . Moreover, our and previous data showed that lung cancers are among the most common malignancy after LTx 22‐24 . Malignant pleural effusions are associated with an increased mortality, 25,26 an association that was confirmed by our survival data of patients with late‐onset effusions.…”

Lung Transplantation in Patients with Cystic Fibrosis

“…PTLD is diagnosed when EBV levels start to rise in association with an abnormal white cell count, and is more common in lung transplant recipients than most other SOT recipients. It occurs in 2-9% of lung transplant recipients [101,102]. Early cases (within 1 year of transplantation) typically involve the lungs and occur in recipients who have not previously been exposed to the virus, whereas cases presenting more than 1 year post-transplantation are more likely to involve the gastrointestinal (GI) tract [101].…”

“…Early-onset PTLD is more likely to respond to a reduction in immunosuppression than late-onset as the pathogenesis of the latter is less well understood, but this in turn increases the risk of rejection and graft failure [104]. As a result, prognosis with late-onset PTLD is worse [102,105]. If reduction in treatment is not the solution, the next option would be rituximab, which induces cell death of B-cells via CD20 which is on the surface of these cells.…”

“…They are also cautioned about time spent in the sun and advised to use high factor sun cream liberally. Squamous cell carcinomas (SCCs) are 100-200 times more likely to occur post-lung transplant compared to the general population [107], and they are usually more aggressive with high rates of recurrence [102]. All other forms of skin cancer are more common than the general population but not to the same extent.…”

Post-transplant malignancies in solid organ recipients: development mechanisms and risk factors

“…С учетом неуклонно возрастающего количества трансплантаций солидных органов во всем мире (только за 2020 год в мире выполнено 113 363 трансплантации солидных органов) и постепенного увеличения продолжительности жизни реципиентов донорских органов актуальность изучения злокачественных новообразований будет только возрастать. Вопросы развития онкозаболеваний у этой категории достаточно подробно освещены в иностранной литературе, тогда как отечественных источников мы не нашли [1][2][3][4][5][6][7][8][9][10][11][12][13]30].…”