Lung cancer: a rare indication for, but frequent complication after lung transplantation

Raemdonck, Dirk Van; Vos, Robin; Yserbyt, Jonas; Decaluwé, Herbert; Leyn, Paul De; Verleden, Geert M.

doi:10.21037/jtd.2016.11.05

Cited by 36 publications

(29 citation statements)

References 85 publications

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“…However, biopsies of suspected lesions can be dangerous, as invasive procedures may result in pneumothorax, empyema, pneumonia, and respiratory insufficiency, which are critically injurious to patients with end-stage IPF. 18 In comparison, endobronchial ultrasound-guided bronchoscopic biopsy of suspicious lung lesions or lymph nodes has been considered to be a less invasive diagnostic modality in patients with end-stage IPF. 19 …”

Section: Discussionmentioning

confidence: 99%

Incidental Lung Cancer of Explanted Lungs from Lung Transplant Recipients: Incidence, Characteristics, and 5-Year Survival

et al. 2020

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Purpose Recent history of malignancy without 5-year disease-free interval is an absolute contraindication for lung transplantation (LTx). However, in rare cases, lung cancer may be incidentally diagnosed in the explanted lung of recipients. We evaluated the prevalence, 5-year survival, and prognosis of incidental lung cancer after LTx. Materials and Methods Medical records of patients who underwent LTx at Severance Hospital between January 1, 2012 and June 30, 2019 were reviewed. Patients with incidental lung cancer were included, and those with histologically proven pre-transplant lung cancer were excluded. Results Of the 247 patients who underwent LTx, 6 (2.4%) were diagnosed with incidental lung cancer. Interstitial lung disease (ILD) was the underlying lung disease in all patients. The median interval from the last preoperative computed tomography (CT) screening to LTx was 26 days. The most common histological type of incidental lung cancer was adenocarcinoma (n=4, 66.7%). All Stage IV cases were misdiagnosed as fibrosis on preoperative chest CT. Patients with incidental lung cancer showed lower 5-year survival than those without malignancy (median survival: 8.5 months vs. not reached, p =0.047, respectively). Patients with Stage III or IV demonstrated lower 5-year survival than those with Stage I or II and those without malignancy (median survival: 5 months, 19 months, and not reached, respectively, p =0.011). Conclusion Multidisciplinary preoperative screening and serial imaging studies within short intervals are required to differentiate lung malignancy from fibrotic foci. Furthermore, active pathologic examination of suspicious lung lesions is required in patients at high risk for lung cancer.

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Section: Discussionmentioning

confidence: 99%

Incidental Lung Cancer of Explanted Lungs from Lung Transplant Recipients: Incidence, Characteristics, and 5-Year Survival

et al. 2020

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“…In the case of the former, unilateral LTx offers an obvious risk in the remaining native lung, with some centers reporting rates approaching 10% of unilateral LTx recipients. 127 By contrast, rates of lung cancer after bilateral LTx appear much lower, at well below 1%. 128 Although it is presumed that these are largely de novo, chimerism is known to occur and tissueresident recipient cells may be detected many months, even years post-LTx 129 and confirmed cases have been reported.…”

Section: Lung Cancer After Ltxmentioning

confidence: 96%

Chronic Obstructive Pulmonary Disease and Lung Transplantation

Greer

Welte

2020

Semin Respir Crit Care Med

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Lung transplantation (LTx) has been a viable option for patients with end-stage chronic obstructive pulmonary disease (COPD), with more than 20,000 procedures performed worldwide. Survival after LTx lags behind most other forms of solid-organ transplantation, with median survival for COPD recipients being a sobering 6.0 years. Given the limited supply of suitable donor organs, not all patients with end-stage COPD are candidates for LTx. We discuss appropriate criteria for accepting patients for LTx, as well as contraindications and exclusionary criteria. In the first year post-LTx, infection and graft failure are the leading causes of death. Beyond this chronic graft rejection—currently referred to as chronic lung allograft dysfunction—represents the leading cause of death at all time points, with infection and over time malignancy also limiting survival. Referral of COPD patients to a lung transplant center should be considered in the presence of progressing disease despite maximal medical therapy. As a rule of thumb, a forced expiratory volume in 1 second < 25% predicted in the absence of exacerbation, hypoxia (PaO2 < 60 mm Hg/8 kPa), and/or hypercapnia (PaCO2 > 50 mm Hg/6.6 kPa) and satisfactory general clinical condition should be considered the basic prerequisites for timely referral. We also discuss salient issues post-LTx and factors that impact posttransplant survival and morbidity such as infections, malignancy, renal insufficiency, and complications associated with long-term immunosuppression.

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“…The risk factors for the development of primary bronchogenic carcinoma in the native lung are older age, previous heavy smoking history and unilateral transplant ( Figure 1 ). The most common underlying disease is pulmonary fibrosis [ 72 ]. In our program, lung neoplasia affected 3.63% of the total transplant population [ 73 ].…”

Section: Post-transplant Monitoringmentioning

confidence: 99%

Lung Transplantation in Idiopathic Pulmonary Fibrosis

et al. 2018

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Despite the advances in recent years in the treatment of idiopathic pulmonary fibrosis (IPF), it continues to be a progressive disease with poor prognosis. In selected patients, lung transplantation may be a treatment option, with optimal results in survival and quality of life. Currently, pulmonary fibrosis is the main cause of lung transplantation. However, mortality on the waiting list of these patients is high, since many patients are referred to the transplant units with advanced disease. There is not a parameter that can predict the survival of a specific patient. Different variables are to be considered in order to decide the right time to send them to a transplant unit. It is also very difficult to decide when to include these patients on the waiting list. Every patient diagnosed with IPF, without contraindications for surgery, should be referred early to a transplant unit for assessment. A uni or bilateral transplantation will be decided based on the characteristics of the patient and the experience of each center. The post-transplant survival of recipients with IPF is lower than that observed in other diseases, such as cystic fibrosis or chronic obstructive pulmonary disease as a consequence of their older age and the frequent presence of associated comorbidity. Post-transplant follow-up must be tight in order to assure optimal level of immunosuppressive treatment, detect complications associated with it, and avoid graft rejection. The main cause of long-term mortality is late graft dysfunction as a consequence of chronic rejection. Other complications, such as infections and tumors, must be considered.

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Lung cancer: a rare indication for, but frequent complication after lung transplantation

Cited by 36 publications

References 85 publications

Incidental Lung Cancer of Explanted Lungs from Lung Transplant Recipients: Incidence, Characteristics, and 5-Year Survival

Incidental Lung Cancer of Explanted Lungs from Lung Transplant Recipients: Incidence, Characteristics, and 5-Year Survival

Chronic Obstructive Pulmonary Disease and Lung Transplantation

Lung Transplantation in Idiopathic Pulmonary Fibrosis

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