Malignancies and lung transplantation

Abstract

After lung transplantation, patients are at risk for postoperative malignancy due to immunosuppression and the high risk of oncogenic virus infection. Concerning the indication for deceased-donor lung transplantation (DDLT) in patients with a history of malignancy, a disease-free interval (DFI) of more than 5 years is required; however, in cases of low risk for recurrence, such as skin cancer and certain types of hematological malignancy, 2 years of DFI is accepted. On the other hand, the indication for living-donor lobar lung transplantation (LDLLT) is discussed on a patient-by-patient basis, and when the estimation of recurrence is considered to be less than 30%, LDLLT is performed. About de novo malignancy after lung transplantation, we retrospectively reviewed the records of 343 (LDLLT: 124, DDLT: 219) patients undergoing lung transplantation between April 2002 and December 2023. Thirty-six patients (10.5%) developed de novo malignancies after lung transplantation. Fifteen patients developed post-transplant lymphoproliferative disorders (PTLD) and 23 developed solid organ malignancies. The 5-year overall survival (OS) rate after lung transplantation in patients diagnosed with de novo malignancies was 70.4%, while it was 81.1% (p＝0.13) in patients without malignancies. The 2-year OS rates after diagnosis in patients with PTLD and solid organ malignancies were 60.0% and 57.3%, respectively (p＝0.58). In patients with solid organ malignancies, the 2-year OS rate in those who received radical treatment was 83.9%; however, it was 12.5% in those who received chemotherapy only or palliative care (p<0.01). Malignancies after lung transplantation may have a significant impact on long-term survival after lung transplantation. Physicians who follow up with lung transplant recipients should be careful about the development of malignancy because radial treatment can provide a better prognosis.