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Elsolh B, Bayat Z, Lyu D, Lin J, Wakeam E. Lung transplantation for lung cancer: A systematic review of the literature. J Heart Lung Transplant 2023; 42:1425-1436. [PMID: 37253398 DOI: 10.1016/j.healun.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 04/05/2023] [Accepted: 05/20/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Lung transplant (LTx) is an accepted treatment for end-stage pulmonary failure. A small proportion of explanted lungs harbor incidentally identified nonsmall cell lung cancers (NSCLC). We review the literature on studies assessing LTx patients found to have NSCLC lung cancer in their explanted lungs, and perform a pooled analysis of outcomes. METHODS MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched. We included studies assessing outcomes of patients with incidentally identified NSCLC following LTx, or following LTx for diffuse lepidic adenocarcinoma as a primary indication. RESULTS A total of 1404 articles were reviewed. 17 eligible studies were identified: 14 studies on incidental NSCLC (N = 169), 4 on diffuse lepidic adenocarcinoma (N = 70). Overall survival (OS) for patients with incidentally identified lung cancer at 1-year, 3-year, and 5-year was 60.8% (95%CI 43.7%-77.9%, I2 =81.8%), 25.5% (95%CI 1.6%-49.5%, I2 =93.6%), and 23.0% (95%CI 2.0%-44.0%, I2 =92.0%) respectively. When restricted to those with earlier stage disease, those with stage I or II NSCLC had better 1-year, 3-year, and 5-year OS at 72.7% (95%CI 57.2%-88.2%, I2 =67.3%), 41.6% (95%CI 14.0%-69.1%, I2 =89.1%), and 34.5% (95%CI 8.1%-61.0%, I2 =89.8%), respectively. A sensitivity analysis limited to stage I showed 1-year, 3-year, and 5-year survival of 73.0% (95%CI 56.3%-89.7%), 40.4% (95%CI 110.3%-70.6%), and 35.4% (95%CI 6.2%-64.5%), respectively. The 4 studies on diffuse lepidic adenocarcinoma were too heterogeneous for pooled analysis. CONCLUSIONS We present a review and pooled analysis examining survival following LTx with incidentally identified NSCLC. Patients with earlier stage incidentally explanted NSCLC had better survival outcomes. OS in the stage I population approximates that of LTx without incidental NSCLC.
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Affiliation(s)
- Basheer Elsolh
- Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Zubair Bayat
- Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Dennis Lyu
- Division of Pulmonary Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jules Lin
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Elliot Wakeam
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
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2
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De Wolf J, Robin E, Vallee A, Cohen J, Hamid A, Roux A, Leguen M, Beaurepere R, Bieche I, Masliah-Planchon J, Glorion M, Allory Y, Sage E. Donor/recipient origin of lung cancer after lung transplantation by DNA short tandem repeat analysis. Front Oncol 2023; 13:1225538. [PMID: 37841427 PMCID: PMC10568626 DOI: 10.3389/fonc.2023.1225538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Background Lung cancer is more common in posttransplant recipients than in the general population. The objective of this study was to examine the chimerism donor/recipient cell origin of graft cancer in recipients of lung transplant. Methods A retrospective chart review was conducted at Foch Hospital for all lung transplantations from 1989 to 2020. Short tandem repeat PCR (STR-PCR) analysis, the gold standard technique for chimerism quantification, was used to determine the donor/recipient cell origin of lung cancers in transplant patients. Results Fourteen (1.4%) of the 1,026 patients were found to have graft lung cancer after lung transplantation, and one developed two different lung tumors in the same lobe. Among the 15 lung tumors, 10 (67%) presented with adenocarcinoma, four (27%) with squamous cell carcinoma and one with small cell lung cancer. STR analysis showed that the origin of the cancer was the donor in 10 patients (71%), the recipient in three patients (21%), and was undetermined in one patient. Median time to diagnosis was 62 months. Conclusion The prevalence of lung cancer in lung transplant recipients is very low. However, the results of our study showed heterogeneity of genetic alterations, with 21% being of recipient origin. Our results highlight the importance of donor selection and medical supervision after lung transplantation.
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Affiliation(s)
- Julien De Wolf
- Department of Thoracic Surgery and Lung Transplantation, Foch Hospital, Suresnes, France
| | - Edouard Robin
- Department of Thoracic Surgery and Lung Transplantation, Foch Hospital, Suresnes, France
| | - Alexandre Vallee
- Department of Clinical Research and Innovation Foch Hospital, Suresnes, France
| | - Justine Cohen
- Department of Anatomopathology, Foch Hospital, Suresnes, France
| | - Abdul Hamid
- Department of Pneumology, Foch Hospital, Suresnes, France
| | - Antoine Roux
- Department of Pneumology, Foch Hospital, Suresnes, France
| | - Morgan Leguen
- Department of Anesthesiology, Foch Hospital, Suresnes, France
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | | | - Ivan Bieche
- Genetics Department, Curie Institut, Paris, France
| | | | - Matthieu Glorion
- Department of Thoracic Surgery and Lung Transplantation, Foch Hospital, Suresnes, France
| | - Yves Allory
- Department of Anatomopathology, Foch Hospital, Suresnes, France
- Department of Anatomopathology, Curie Institut, Paris, France
| | - Edouard Sage
- Department of Thoracic Surgery and Lung Transplantation, Foch Hospital, Suresnes, France
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
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3
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Tseng SC, Gagne S, Hatabu H, Lin G, Sholl L, Nishino M. Lung Cancer in Lung Transplant Recipients: Clinical, Radiologic, and Pathologic Characteristics and Treatment Outcome. J Comput Assist Tomogr 2023; 47:590-597. [PMID: 36944140 PMCID: PMC10363202 DOI: 10.1097/rct.0000000000001466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE This study aimed to investigate clinical and radiologic characteristics of lung cancer in lung transplant recipients and evaluate the treatment course and prognosis. METHODS The study included 448 patients who underwent lung transplant between 2005 and 2021. All patients had pretransplant chest computed tomography (CT), 429 patients had posttransplant CT, whereas 19 had no posttransplant CT (median number of posttransplant CT, 6; range, 0-24). Medical records of these patients were reviewed to identify patients who developed lung cancer after lung transplant. Computed tomography and positron emission tomography/CT at the time of lung cancer diagnoses were reviewed to obtain imaging features. Demographics, tumor histology, stages, and survival were compared using Fisher exact test and Wilcoxon rank sum test. RESULTS Among 448 lung transplant recipients with a median follow-up of 71.3 months after lung transplant, 15 patients (3.3%) developed posttransplant lung cancer (13 unilateral, 2 bilateral; 10 men, 5 women; median age, 63.1 years; median time from transplantation to cancer diagnosis, 3.1 years). Twelve cancers were in native lung, and 3 were in transplanted lung. The incidence of lung cancer was higher in single lung transplant recipients than in bilateral lung transplant recipients (10.3% vs 0.6%, respectively; P < 0.0001). Imaging manifestations varied according to tumor stages. Among 12 patients treated for lung cancer, 2 patients developed posttreatment acute respiratory distress syndrome. The median survival from cancer diagnosis of cancer was 6.2 months. CONCLUSIONS Posttransplant lung cancer was noted in 3% of lung transplant recipients and was more common in unilateral transplant recipients. The prognosis upon diagnosis was poor with rapid clinical deterioration and serious posttreatment complications.
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Affiliation(s)
- Shu-Chi Tseng
- Department of Imaging, Dana-Farber Cancer Institute 450 Brookline Ave. Boston MA, 02215, USA
- Department of Radiology, Brigham and Women’s Hospital 75 Francis St. Boston MA, 02215, USA
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Staci Gagne
- Department of Imaging, Dana-Farber Cancer Institute 450 Brookline Ave. Boston MA, 02215, USA
- Department of Radiology, Brigham and Women’s Hospital 75 Francis St. Boston MA, 02215, USA
| | - Hiroto Hatabu
- Department of Imaging, Dana-Farber Cancer Institute 450 Brookline Ave. Boston MA, 02215, USA
- Department of Radiology, Brigham and Women’s Hospital 75 Francis St. Boston MA, 02215, USA
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Lynnette Sholl
- Department of Pathology, Brigham and Women’s Hospital 75 Francis St. Boston MA, 02215, USA
| | - Mizuki Nishino
- Department of Imaging, Dana-Farber Cancer Institute 450 Brookline Ave. Boston MA, 02215, USA
- Department of Radiology, Brigham and Women’s Hospital 75 Francis St. Boston MA, 02215, USA
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4
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Subramanian M, Meyers BF. Lung Transplant Procedure of Choice: Bilateral Transplantation Versus Single Transplantation Complications, Quality of Life, and Survival. Clin Chest Med 2023; 44:47-57. [PMID: 36774167 DOI: 10.1016/j.ccm.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
This article examines the existing literature regarding single (SLT) and bilateral lung transplantation (BLT) to help answer the question of which approach is preferable. Specifically, this review highlights the following subjects: disease-specific indications for SLT versus BLT; the impact of procedure type on posttransplantation functional status; the impact of procedure type on posttransplantation quality of life; chronic rejection after lung transplantation; ethical challenges facing the choice between single and bilateral transplants; and, novel strategies in this arena.
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Affiliation(s)
- Melanie Subramanian
- Washington University, School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO, USA
| | - Bryan F Meyers
- Washington University, School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO, USA.
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5
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Delaney FT, Murray JG, Hutchinson BD, Egan JJ, Murray M, Winward S, Ronan N, Cronin CG. The role of radiology in addressing the challenge of lung cancer after lung transplantation. Eur Radiol 2022; 32:8182-8190. [PMID: 35708839 DOI: 10.1007/s00330-022-08942-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/11/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
The importance of lung cancer as a complication of lung transplantation is increasingly recognised. It may become an important survival-limiting factor in lung transplant patients as management of other complications continues to improve and utilisation of extended criteria donors grows. Radiology can play a key role in tackling this issue at multiple stages in the transplantation pathway and follow-up process. Routine chest CT as part of pre-transplant recipient assessment (and donor assessment if available) can identify suspicious lung lesions with high sensitivity and detect chronic structural lung diseases such as pulmonary fibrosis associated with an increased risk of malignancy post-transplant. Pre-transplant CT also provides a comparison for later CT studies in the assessment of nodules or masses. The potential role of regular chest CT for lung cancer screening after transplantation is less certain due to limited available evidence on its efficacy. Radiologists should be cognisant of how the causes of pulmonary nodules in lung transplant patients may differ from the general population, vary with time since transplantation and require specific recommendations for further investigation/follow-up as general guidelines are not applicable. As part of the multidisciplinary team, radiology is involved in an aggressive diagnostic and therapeutic management approach for nodular lung lesions after transplant both through follow-up imaging and image-guided tissue sampling. This review provides a comprehensive overview of available clinical data and evidence on lung cancer in lung transplant recipients, and in particular an assessment of the current and potential roles of pre- and post-transplant imaging. KEY POINTS: • Lung cancer after lung transplantation may become an increasingly important survival-limiting factor as mortality from other complications declines. • There are a number of important roles for radiology in tackling the issue which include pre-transplant CT and supporting an aggressive multidisciplinary management strategy where lung nodules are detected in transplant patients. • The introduction of routine surveillance chest CT after transplant in addition to standard clinical follow-up as a means of lung cancer screening should be considered.
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Affiliation(s)
- Francis T Delaney
- Radiology Department, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - John G Murray
- Radiology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Barry D Hutchinson
- Radiology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jim J Egan
- National Heart and Lung Transplant Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michelle Murray
- National Heart and Lung Transplant Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sara Winward
- National Heart and Lung Transplant Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Nicola Ronan
- National Heart and Lung Transplant Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Carmel G Cronin
- Radiology Department, Mater Misericordiae University Hospital, Dublin, Ireland
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6
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Kapnadak SG, Raghu G. Lung transplantation for interstitial lung disease. Eur Respir Rev 2021; 30:30/161/210017. [PMID: 34348979 DOI: 10.1183/16000617.0017-2021] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/02/2021] [Indexed: 01/18/2023] Open
Abstract
Lung transplantation (LTx) can be a life-extending treatment option for patients with advanced and/or progressive fibrotic interstitial lung disease (ILD), especially idiopathic pulmonary fibrosis (IPF), fibrotic hypersensitivity pneumonitis, sarcoidosis and connective tissue disease-associated ILD. IPF is now the most common indication for LTx worldwide. Several unique features in patients with ILD can impact optimal timing of referral or listing for LTx, pre- or post-transplant risks, candidacy and post-transplant management. As the epidemiology of LTx and community practices have evolved, recent literature describes outcomes and approaches in higher-risk candidates. In this review, we discuss the unique and important clinical findings, course, monitoring and management of patients with IPF and other progressive fibrotic ILDs during pre-LTx evaluation and up to the day of transplantation; the need for co-management with clinical experts in ILD and LTx is emphasised. Some post-LTx complications are unique in these patient cohorts, which require prompt detection and appropriate management by experts in multiple disciplines familiar with telomere biology disorders and infectious, haematological, oncological and cardiac complications to enhance the likelihood of improved outcomes and survival of LTx recipients with IPF and other ILDs.
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Affiliation(s)
- Siddhartha G Kapnadak
- Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Medicine, University of Washington, Seattle, WA, USA
| | - Ganesh Raghu
- Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Medicine, University of Washington, Seattle, WA, USA .,Dept of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
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7
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Choi YJ, Kim SY, Park MS, Lee JG, Paik HC, Lee SH. Incidental Lung Cancer of Explanted Lungs from Lung Transplant Recipients: Incidence, Characteristics, and 5-Year Survival. Yonsei Med J 2020; 61:958-964. [PMID: 33107239 PMCID: PMC7593106 DOI: 10.3349/ymj.2020.61.11.958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/13/2020] [Accepted: 09/24/2020] [Indexed: 11/27/2022] Open
Abstract
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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Affiliation(s)
- Yong Jun Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Song Yee Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Suk Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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8
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Primary lung carcinoma in cystic fibrosis: A case report and literature review. Respir Med Case Rep 2020; 31:101242. [PMID: 33117646 PMCID: PMC7582100 DOI: 10.1016/j.rmcr.2020.101242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 11/22/2022] Open
Abstract
Patients with cystic fibrosis (CF) have increased life span because of improved care over last 50 years. With increasing survival, predisposition of cancer may become evident. We have observed increase risk of gastrointestinal tract cancer, testicular cancer and lymphoid leukemia. Lung cancer in patients with CF is rare. Our patient developed chronic respiratory failure due to CF related bronchiectasis. Patient had progressive disease despite optimum treatment, requiring lung transplantation. Pathology of explant lung showed focus of invasive adenocarcinoma of lung origin. Patient had no evidence of lung carcinoma recurrence in one year. To our knowledge this is the fourth reported lung cancer case in a patient with CF.
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9
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Young K, Jiang H, Marquez M, Yeung J, Shepherd FA, Renner E, Keshavjee S, Kim J, Ross H, Aliev T, Liu G, Leighl NB, Feld R, Bradbury P. Retrospective study of the incidence and outcomes from lung cancer in solid organ transplant recipients. Lung Cancer 2020; 147:214-220. [PMID: 32738417 DOI: 10.1016/j.lungcan.2020.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/29/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Organ transplant recipients (OTR) have an increased risk of developing post-transplant malignancies with lung cancer being one of the most common. In this retrospective study, we investigated incidence, use of systemic therapy and outcomes from lung cancer in OTR. MATERIALS AND METHODS Patients diagnosed with lung cancer following a solid organ transplant at the University Health Network, Toronto, ON, CA, from January 1, 1980 to June 30, 2016 were included. Data for the study population, patient characteristics, treatments and outcomes were abstracted from solid OTR databases, our cancer registry and patient charts. Univariate Kaplan-Meier curves estimated median overall survival (OS) by histology, stage and systemic therapy. RESULTS Amongst 7944 OTR (heart [N = 765], lung [n = 1668], liver [n = 2238], kidney [n = 3273]), 101 (1.3 %) developed lung cancer which were included in our analyses. Of these, 81 % were non-small cell lung cancer (NSCLC), 11 % small cell lung cancer (SCLC) and 8% neuroendocrine tumor (NET). Median OS (months) was 25 in those that presented with Stage I/II NSCLC (44 %); 25 for Stage III NSCLC (7%); 3 for Stage IV NCLC (31 %); 10 for Limited stage SCLC (6%); 2 for Extensive stage (ES) SCLC (5%). NSCLC patients that received palliative chemotherapy had an OS of 8 months; ES-SCLC patients that received chemotherapy had an OS of 6 months. Of all patients who received platinum doublets (n = 16), 10 (62.5 %) required dose reductions at some point. Five patients experienced febrile neutropenia (31 %); two (12 %) had other toxicities leading to discontinuation. CONCLUSION Patients with stage I/II NSCLC and NET had poorer survival compared to historical norms in non-transplant patients. Patients who had stage III NSCLC or received palliative systemic therapy had survivals at or slightly below historic norms, although numbers were small. Chemotherapy can be administered in selected OTR patients though dose reductions and febrile neutropenia were common.
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Affiliation(s)
- Kelvin Young
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada.
| | - Haiyan Jiang
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Max Marquez
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Jonathan Yeung
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Frances A Shepherd
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Eberhard Renner
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Shaf Keshavjee
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Joseph Kim
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Heather Ross
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Tim Aliev
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Geoffrey Liu
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Natasha B Leighl
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Ronald Feld
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Penelope Bradbury
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
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10
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Greer M, Welte T. Chronic Obstructive Pulmonary Disease and Lung Transplantation. Semin Respir Crit Care Med 2020; 41:862-873. [PMID: 32726838 DOI: 10.1055/s-0040-1714250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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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Affiliation(s)
- Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany
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11
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Gershman E, Zer A, Pertzov B, Shtraichman O, Shitenberg D, Heching M, Rosengarten D, Kramer M. Characteristics of lung cancer in idiopathic pulmonary fibrosis with single lung transplant versus non-transplanted patients: a retrospective observational study. BMJ Open Respir Res 2020; 7:7/1/e000566. [PMID: 32565443 PMCID: PMC7311020 DOI: 10.1136/bmjresp-2020-000566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/01/2020] [Accepted: 05/22/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients with idiopathic pulmonary fibrosis (IPF) have significantly higher incidence of lung cancer (LC) relative to the general population. There is a further increase in LC incidence in patients with IPF subsequent to lung transplant, specifically in patients with IPF undergoing single lung transplant. OBJECTIVES To examine the incidence and characteristics of LC in patients with IPF during follow-up and after lung transplantation (LTX). METHODS We conducted a retrospective analysis of all patients with IPF diagnosed with LC in Rabin Medical Center, Israel, over an 11-year period. We compared the characteristics of transplanted patients with IPF diagnosed with LC to patients with IPF who did not undergo lung transplant. Data were accessed from database registries using the words 'fibrosis', 'lung-cancer' and 'lung-transplantation'. Demographic parameters included age, gender and smoking history (pack years). Clinical-pathological parameters included lapse in time from IPF diagnosis to LC, type of malignancy, affected pulmonary lobe, and stage at diagnosis, oncological treatment and survival. RESULTS Between 2008 and 2018, 205 patients with IPF underwent lung transplantation at our medical centre. Double LTX was performed in 83 and single LTX in 122 cases. Subsequently, 15 (12.3%) single LTX patients were diagnosed with LC during the study period. During the same period, of 497 non-transplanted patients with IPF followed in our centre, 45 (9.1%) were diagnosed with LC. In all 15 transplanted patients with IPF, LC was diagnosed exclusively in the native fibrotic lung. LC incidence was higher in the transplanted as compared with the non-transplanted group, but this difference did not reach statistical significance (OR=0.7, 95% CI 0.38 to 1.32, p=0.28). At LC diagnosis, the non-transplanted group was older than the transplanted group with average age of 67.7 versus 60.8 years, respectively (p=0.006). Both groups showed male predominance. In both groups, LC was primarily peripheral, lower lobe predominant and most frequently squamous cell carcinoma. The median survival time after LC diagnosis was 4 months in the transplanted group and 11 months in the non-transplanted group (p=0.19). Multivariate analysis showed improved survival in the non-transplanted group among those patients who received oncological treatment. CONCLUSION Chest CT should be performed regularly in order to evaluate IPF patients for potential LC. Single lung transplant IPF patients face an increased risk of post-transplant LC in the native fibrotic lung. Where practicable, IPF patients should be prioritised for double lung transplant.
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Affiliation(s)
- Evgeni Gershman
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alona Zer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Davidoff Oncology Institute, Rabin Medical Center, Petah Tikva, Israel
| | - Barak Pertzov
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Shtraichman
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit Shitenberg
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Heching
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Kramer
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Chen LN, Spivack J, Cao T, Saqi A, Benvenuto LJ, Bulman WA, Mathew M, Stoopler MB, Arcasoy SM, Stanifer BP, Rizvi NA, Shu CA. Characteristics and outcomes of lung cancer in solid organ transplant recipients. Lung Cancer 2020; 146:297-302. [PMID: 32619780 DOI: 10.1016/j.lungcan.2020.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Lung cancer is the third most common malignancy that develops in patients following solid organ transplantation and is the leading cause of cancer deaths in the general population. The aims of this study are to examine the characteristics of patients who developed lung cancer following solid organ transplantation at our institution and to compare their outcomes to those of lung cancer patients without a history of transplant. MATERIALS AND METHODS We performed a single-institution retrospective study of 44 solid organ transplant recipients who developed lung cancer and compared their characteristics to a cohort of 74 lung cancer patients without a history of transplant. We performed propensity score weighted analyses to compare outcomes between the two groups, including a cox proportional hazards model of overall survival. RESULTS 52 % of post-transplant patients who developed lung cancer were diagnosed with stage III or IV disease. In the propensity score weighted analysis that accounted for age at diagnosis, sex, lung cancer stage at diagnosis, Charlson comorbidity index score, and ECOG performance score, post-transplant patients were more likely to have squamous cell histology (p < 0.01) and had worse overall survival compared to the non-transplant cohort (HR = 1.88, 95 % CI 1.13-3.12, p = 0.02). The difference in survival remained significant after accounting for differences in lung cancer histology and treatment (HR = 2.40, 95 % CI 1.27-3.78, p < 0.01). CONCLUSIONS When compared to non-transplant patients with lung cancer, post-transplant patients have worse overall survival after accounting for differences in age, sex, lung cancer stage, comorbidities, and performance status. This survival difference is not solely attributable to differences in tumor histology and treatments received. This may suggest that post-transplant malignancies are more aggressive and difficult to treat.
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Affiliation(s)
- Lanyi Nora Chen
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - John Spivack
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, United States.
| | - Thu Cao
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Surgery, Columbia University Medical Center, United States.
| | - Anjali Saqi
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Pathology, Columbia University Medical Center, United States.
| | - Luke J Benvenuto
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - William A Bulman
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - Matthen Mathew
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - Mark B Stoopler
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - Selim M Arcasoy
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - Bryan P Stanifer
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Surgery, Columbia University Medical Center, United States.
| | - Naiyer A Rizvi
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - Catherine A Shu
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
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13
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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 2nd 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.
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Affiliation(s)
- Osnat Shtraichman
- Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Pulmonary Institute, Rabin Medical Center, Affiliated with Sackler School of Medicine Tel Aviv University, Petach Tikva, Israel
| | - Vivek N Ahya
- Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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14
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Bosacki C, Vallard A, Jmour O, Ben Mrad M, Lahmamssi C, Bousarsar A, Vial N, Guillaume E, Daguenet E, Magné N. [Radiotherapy and immune suppression: A short review]. Bull Cancer 2019; 107:84-101. [PMID: 31866074 DOI: 10.1016/j.bulcan.2019.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 01/28/2023]
Abstract
The management of patients undergoing immunosuppressive agents is really challenging. Based on precaution principle, it seems mandatory to stop immunosuppressive (or immunomodulating) agents during radiation. Yet, it is impossible in grafted patients. It is possible in patients with autoimmune disease, but in this case, the autoimmune disease might modify patient's radio-sensitivity. We provide a short review about the safety of radiotherapy in grafted/auto-immune patients. The literature is limited with data coming from outdated case-report or case-control studies. It seems that radiotherapy is feasible in grafted patients, but special dose-constraints limitations must probably be considered for the transplant and the other organs at risk. There is very little data about the safety of radiotherapy, when associated with immunomodulating agents. The most studied drug is the methotrexate but only its prescription as a chemotherapy (high doses for a short period of time) was reported. When used as an immunomodulator, it should probably be stopped 4 months before and after radiation. Apart from rheumatoid arthritis, it seems that collagen vascular diseases and especially systemic scleroderma and systemic lupus erythematous feature increased radio-sensitivity with increased severe late toxicities. Transplanted patients and collagen vascular disease patients should be informed that there is very little data about safety of radiation in their case.
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Affiliation(s)
- Claire Bosacki
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France.
| | - Alexis Vallard
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Omar Jmour
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Majed Ben Mrad
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Chaimaa Lahmamssi
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Amal Bousarsar
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Nicolas Vial
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Elodie Guillaume
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Elisabeth Daguenet
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France; Institut de cancérologie Lucien-Neuwirth, département universitaire de recherche et éducation, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Nicolas Magné
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France; Institut de cancérologie Lucien-Neuwirth, département universitaire de recherche et éducation, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
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15
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Omar A, Patil PD, Hoshi S, Huang J, Collum E, Panchabhai TS. A 68-Year-Old Lung Transplant Recipient With Shortness of Breath, Weight Loss, and Abnormal Chest CT. Chest 2019; 153:e153-e157. [PMID: 29884278 PMCID: PMC7094713 DOI: 10.1016/j.chest.2017.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/11/2017] [Accepted: 10/30/2017] [Indexed: 12/01/2022] Open
Abstract
A 68-year-old man presented to our ED with shortness of breath, weakness, and a 25-lb unintentional weight loss. He had undergone bilateral lung transplantation (cytomegalovirus [CMV]: donor+, recipient+; Epstein-Barr virus: donor+; recipient+) for idiopathic pulmonary fibrosis (IPF) 18 months prior. His posttransplant course was fairly unremarkable until 1 month earlier, when he was admitted for breathlessness and weakness. CT of the chest during that admission revealed mild intralobular and interlobular septal thickening. A bronchoscopy with BAL and transbronchial biopsies did not show acute cellular rejection, but the BAL fluid was positive for coronavirus. His cortisol level was undetectable; he was diagnosed with adrenal insufficiency and fludrocortisone was initiated. He was taking prednisone, tacrolimus, and everolimus for immunosuppression and valganciclovir, itraconazole, and trimethoprim-sulfamethoxazole for antimicrobial prophylaxis. His 25-lb weight loss occurred over the span of just one month.
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Affiliation(s)
- Ashraf Omar
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Pradnya D Patil
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Sami Hoshi
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Jasmine Huang
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Earle Collum
- Department of Pathology, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Tanmay S Panchabhai
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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16
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17
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Triplette M, Crothers K, Mahale P, Yanik EL, Valapour M, Lynch CF, Schabath MB, Castenson D, Engels EA. Risk of lung cancer in lung transplant recipients in the United States. Am J Transplant 2019; 19:1478-1490. [PMID: 30565414 PMCID: PMC6872188 DOI: 10.1111/ajt.15181] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/23/2018] [Accepted: 11/06/2018] [Indexed: 01/25/2023]
Abstract
Lung transplant recipients have an increased risk of lung cancer that is poorly understood. Prior studies are largely descriptive and single-center, and have not examined risk factors or outcomes in this population. This registry-linkage study utilized matched transplant and cancer registry data from 17 US states/regions during 1987-2012. We used standardized incidence ratios (SIRs) to compare incidence with the general population, Poisson models to identify lung cancer risk factors, and Cox models to compare survival after diagnosis. Lung cancer risk was increased among lung recipients (SIR 4.8, 95% confidence interval [CI] 4.1-5.5). Those with single lung transplant had 13-fold (95% CI 11-15) increased risk in the native lung. Native lung cancer risk factors included age, prior smoking, time since transplant, and idiopathic pulmonary fibrosis. Compared with cases in the general population, lung cancers in recipients were more frequently localized stage (P = .02) and treated surgically (P = .05). However, recipients had higher all-cause (adjusted hazard ratio 1.90, 95% CI 1.52-2.37) and cancer-specific mortality (adjusted hazard ratio 1.67, 95% CI 1.28-2.18). In conclusion, lung cancer risk is increased after lung transplant, especially in the native lung of single lung recipients. Traditional risk factors are associated with lung cancer in these patients. Lung cancer survival is worse among lung recipients despite earlier diagnosis.
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Affiliation(s)
- Matthew Triplette
- Department of Medicine, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Elizabeth L. Yanik
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Maryam Valapour
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Charles F. Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Matthew B. Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | - Eric A. Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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18
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Fitton I, Revel MP, Burgel PR, Hernigou A, Boussaud V, Guillemain R, Le Pimpec-Barthes F, Bennani S, Freche G, Frija G, Chassagnon G. Cumulative radiation dose after lung transplantation in patients with cystic fibrosis. Diagn Interv Imaging 2019; 100:287-294. [DOI: 10.1016/j.diii.2018.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/17/2018] [Accepted: 12/20/2018] [Indexed: 12/12/2022]
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19
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Rodrigues D, Borro JM, Amado J, Vaz AP. Metachronous Pulmonary Neoplasms in Lung Transplantation-When They Arise in the Donor Lung: A Case Report. Transplant Proc 2018; 50:4075-4079. [PMID: 30577319 DOI: 10.1016/j.transproceed.2018.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 11/26/2022]
Abstract
Lung cancer (LC) is uncommon among lung transplant recipients, being most often described in the native lung of single-lung transplant recipients. Its appearance in the transplanted lung is a very uncommon phenomenon, in which donor and recipient factors appear to be involved. We present a case of 2 distinct metachronous lung neoplasms diagnosed in the transplanted lung of a non-smoker patient with progressive massive silicosis (PMS), who underwent left unipulmonary transplantation at 39 years. The donor was a smoker and thoracic computed tomography (CT) performed before the organ collection showed no abnormalities. Thirty months after transplantation, a new node with significant avidity in positron emission tomography (PET)-CT was diagnosed in the upper left lobe (ULL). The Thoracic Surgery team chose to proceed directly to surgery with atypical resection of the nodule. Anatomopathologic study revealed an epidermoid carcinoma (pT1aNx). Multidisciplinary group decided clinical surveillance; however, 2 years later, the appearance of 2 new nodules in the ULL (PET-CT positive) was observed. It was again decided to proceed to the surgery with a second atypical resection. The anatomopathologic study of one nodule revealed pulmonary adenocarcinoma (pT1aNx), and the other was compatible with epidermoid carcinoma (pT1aNx). One month later, the patient was hospitalized with a pulmonary abscess and posteriorly developed a probable acute allograft rejection, eventually dying at the age of 44, 51 months after transplantation. This case raises relevant questions regarding the donor selection criteria and the approach to LC diagnosed in the post-transplantation period.
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Affiliation(s)
- D Rodrigues
- Pulmonology Department, Hospital Pedro Hispano, Senhora da Hora, Matosinhos, Portugal.
| | - J M Borro
- Department of Thoracic Surgery and Lung Transplantation, Coruña University Hospital, Coruña, Spain
| | - J Amado
- Pulmonology Department, Hospital Pedro Hispano, Senhora da Hora, Matosinhos, Portugal
| | - A P Vaz
- Pulmonology Department, Hospital Pedro Hispano, Senhora da Hora, Matosinhos, Portugal
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20
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Chatron E, Dégot T, Salvaterra E, Dumazet A, Porzio M, Hirschi S, Schuller A, Massard G, Renaud-Picard B, Kessler R. Lung cancer after lung transplantation: An analysis of 25 years of experience in a single institution. Clin Transplant 2018; 33:e13446. [DOI: 10.1111/ctr.13446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/26/2018] [Accepted: 11/04/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Eva Chatron
- Groupe de transplantation pulmonaire; Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil; Strasbourg Cedex France
| | - Tristan Dégot
- Groupe de transplantation pulmonaire; Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil; Strasbourg Cedex France
| | - Elena Salvaterra
- Groupe de transplantation pulmonaire; Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil; Strasbourg Cedex France
| | - Antoine Dumazet
- Groupe de transplantation pulmonaire; Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil; Strasbourg Cedex France
| | - Michele Porzio
- Groupe de transplantation pulmonaire; Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil; Strasbourg Cedex France
| | - Sandrine Hirschi
- Groupe de transplantation pulmonaire; Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil; Strasbourg Cedex France
| | - Armelle Schuller
- Groupe de transplantation pulmonaire; Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil; Strasbourg Cedex France
| | - Gilbert Massard
- Groupe de transplantation pulmonaire; Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil; Strasbourg Cedex France
| | - Benjamin Renaud-Picard
- Groupe de transplantation pulmonaire; Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil; Strasbourg Cedex France
| | - Romain Kessler
- Groupe de transplantation pulmonaire; Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil; Strasbourg Cedex France
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21
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Santambrogio L, Tarsia P, Mendogni P, Tosi D. Transplant options for end stage chronic obstructive pulmonary disease in the context of multidisciplinary treatments. J Thorac Dis 2018; 10:S3356-S3365. [PMID: 30450242 DOI: 10.21037/jtd.2018.04.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Lung transplantation (LTx) in advanced stage chronic obstructive pulmonary disease (COPD) patients is associated with significant improvement in lung function and exercise capacity. However, demonstration that the procedure also provides a survival benefit has been more elusive compared to other respiratory conditions. Identification of patients with increased risk of mortality is crucial: a low forced expiratory volume in 1 second (FEV1) is perhaps the most common reason for referral to a lung transplant center, but in itself is insufficient to identify which COPD patients will benefit from LTx. Many variables have to be considered in the selection of candidates, time for listing, and choice of procedure: age, patient comorbidities, secondary pulmonary hypertension, the balance between individual and community benefit. This review will discuss patient selection, transplant listing, potential benefits and critical issues of bilateral (BLTx) and single lung (SLTx) procedure, donor-to-recipient organ size-matching; furthermore, it will describe LTx outcomes and its effects on recipient survival and quality of life.
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Affiliation(s)
- Luigi Santambrogio
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Tarsia
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Tosi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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22
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Chen H, Tikkanen J, Boldt RG, Louie AV. Stereotactic ablative radiotherapy for early-stage lung cancer following double lung transplantation. Radiat Oncol 2018; 13:142. [PMID: 30086765 PMCID: PMC6081952 DOI: 10.1186/s13014-018-1089-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/27/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Development of primary lung cancer in donor lung post-lung transplantation is very rare, with few described cases. The safety of stereotactic ablative radiotherapy (SABR) for early-stage lung cancer arising from donor lung is unclear. CASE PRESENTATION Herein, we present a case of a patient with a Stage IB adenocarcinoma arising from donor lung 8 years post-double lung transplantation, which was performed due to advanced emphysema. The patient was ineligible for surgical management due to chronic lung allograft dysfunction, which significantly compromised pulmonary function. Full dose SABR was delivered with curative intent after a discussion with the patient. The patient tolerated the treatment well, with one episode of subacute toxicity that resolved with treatment. There was no evidence of recurrence at 15 months post-treatment and the patient's pulmonary function did not deviate from the pre-SABR baseline. CONCLUSIONS SABR appears feasible for medically-inoperable early-stage primary lung adenocarcinoma in the setting of previous double-lung transplantation.
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Affiliation(s)
- Hanbo Chen
- Department of Radiation Oncology, London Health Sciences Centre, 790 Commissioners Road East, London, ON, N6A 4L6, Canada
| | - Jussi Tikkanen
- Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - R Gabriel Boldt
- Department of Radiation Oncology, London Health Sciences Centre, 790 Commissioners Road East, London, ON, N6A 4L6, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, London Health Sciences Centre, 790 Commissioners Road East, London, ON, N6A 4L6, Canada.
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23
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Subramanian MP, Meyers BF. Bilateral versus single lung transplantation: are two lungs better than one? J Thorac Dis 2018; 10:4588-4601. [PMID: 30174911 DOI: 10.21037/jtd.2018.06.56] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is a long-standing debate over whether single or bilateral lung transplant provides better short and long-term clinical outcomes. We performed a detailed PubMed search on relevant clinical research publications on single (SLT) and bilateral lung transplantation (BLT). We included studies that were published before and after the implementation of the lung allocation score (LAS). We reviewed disease-specific short- and long-term outcomes associated with each transplantation technique. The majority of published studies are retrospective cohort studies that use institutional data or large patient registries. Outcomes associated with transplantation technique vary by disease specific indication, age, and patient severity. Over the past decade, the relative proportion of bilateral lung transplantation has increased. Increasing adoption of bilateral lung transplant likely reflects the general acceptance of several advantages associated with the technique. However, making a clear, evidence-based decision is difficult in light of the fact that there has never been and probably never will be a randomized trial. Our institutional preference is bilateral lung transplant. However, consideration for the technique should still be made on a case-by-case basis.
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Affiliation(s)
- Melanie P Subramanian
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
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24
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Abstract
Lung transplantation has become an efficient life-saving treatment for patients with end stage respiratory disease. The increasing good outcome following lung transplantation may be explained by growing experience of transplant teams and availability of potent immunosuppressive drugs. Nevertheless, the latter carries an inherent risk for malignancy besides other common side effects such as systemic hypertension, diabetes and renal dysfunction. Malignancies occur in a smaller proportion of patients but explain for a large proportion of deaths following transplantation. From the first year post-transplantation they will represent the third cause of death with an increasing incidence along post lung transplant survival. In this chapter, we will browse the different types of malignancies arising following lung transplantation. According to the different techniques for lung transplantation, specific types of bronchogenic carcinoma will be described in the explanted lung, in the native lung, and in the graft. Risk factors associated to immunosuppressive therapy, but also to occupational and environmental factors, especially smoking, will be discussed. Eventually, we will strive at integrating recommendations for the treatment of malignancies following lung transplantation.
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Affiliation(s)
- Anne Olland
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg, France.,INSERM (French institute for health and medical research) 1260 Regenerative Nanomedecine, Translational Medicine Federation of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Pierre-Emmanuel Falcoz
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg, France.,INSERM (French institute for health and medical research) 1260 Regenerative Nanomedecine, Translational Medicine Federation of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Gilbert Massard
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg, France.,INSERM (French institute for health and medical research) 1260 Regenerative Nanomedecine, Translational Medicine Federation of Strasbourg, University of Strasbourg, Strasbourg, France
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25
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Kumar A, Kapnadak SG, Girgis RE, Raghu G. Lung transplantation in idiopathic pulmonary fibrosis. Expert Rev Respir Med 2018; 12:375-385. [DOI: 10.1080/17476348.2018.1462704] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Anupam Kumar
- Division of Pulmonary & Critical Care Medicine, Richard DeVos Heart & Lung Transplant Program, Spectrum Health-Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Siddhartha G. Kapnadak
- Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Reda E. Girgis
- Medical Director, Lung Transplantation and Pulmonary Hypertension, Richard DeVos Heart & Lung Transplant Program, Spectrum Health- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Ganesh Raghu
- Center for Interstitial Lung Diseases, Division of Pulmonary & Critical Care Medicine, University of Washington Medical Center, Seattle, WA, USA
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National survey of de novo malignancy after solid organ transplantation in Japan. Surg Today 2018; 48:618-624. [DOI: 10.1007/s00595-018-1628-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/18/2018] [Indexed: 02/06/2023]
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Li RT, Zahedi S, Trieu J, Lea AS, Calhoun WJ, Duarte AG, Zhao J, Okereke IC. Post-transplant native pneumonectomy for interstitial fibrosis and small cell lung cancer. J Thorac Dis 2018; 9:E1096-E1099. [PMID: 29312773 DOI: 10.21037/jtd.2017.10.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Lung transplantation is a definitive treatment for select patients with end-stage pulmonary disease. Following transplantation, the reported rate of lung cancer is between 1-9% and is associated with a variety of risk factors, including smoking history and chronic immunosuppression. The majority of post-transplant lung cancer reported in the literature is histologically classified as non-small cell lung carcinoma (NSCLC). We report a unique case of early stage small cell lung carcinoma (SCLC) identified in the native lung following single lung transplantation.
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Affiliation(s)
- Ramon T Li
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Sanam Zahedi
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Judy Trieu
- Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Alfred S Lea
- Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - William J Calhoun
- Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Alexander G Duarte
- Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Jianping Zhao
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Ikenna C Okereke
- Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
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Acuna SA, Lam W, Daly C, Kim SJ, Baxter NN. Cancer evaluation in the assessment of solid organ transplant candidates: A systematic review of clinical practice guidelines. Transplant Rev (Orlando) 2017; 32:29-35. [PMID: 29169958 DOI: 10.1016/j.trre.2017.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Active malignancies are a contraindication to transplantation, as immunosuppression can lead to worse cancer outcomes; therefore, ensuring transplant candidates are free of malignancy before transplantation is essential. This systematic review assesses the availability, quality, and consistency of recommended cancer evaluation prior to transplantation in Clinical Practice Guidelines (CPGs) for the selection of solid organ transplant candidates. METHODS We systematically searched for CPGs for the assessment of transplant candidates. The characteristics of included CPGs, strength of recommendations and supporting evidence were extracted. A quality assessment of the CPGs was conducted using the AGREE II tool. RESULTS We identified 52 CPG for the selection of solid organ transplant candidates. Only 13 (25%) included recommendations for cancer evaluation as part of the assessment of transplant candidates. Most recommended age and sex appropriate cancer screening as per the general population guidelines. Recommendations to evaluate for other malignancies and for high-risk candidates were variable. Most recommendations were based on expert opinion and only two CPGs provided an explicit link between the recommendations and supporting evidence. CONCLUSION There is a lack of clear and consistent recommendations for pretransplant cancer evaluation in existing CPGs. Although there is some consensus regarding the indication to screen for cancer as per the recommendations for the general population, these recommendations are not an appropriate risk reduction strategy for transplant candidates. Standardized protocols to ensure transplant candidates are cancer free prior to transplantation are needed.
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Affiliation(s)
- Sergio A Acuna
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.; Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Winnie Lam
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.; Department of Surgery, St. Michael's Hospital, Toronto, Canada.; Ryerson University, Daphne Cockwell School of Nursing, Toronto, Canada
| | - Corinne Daly
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.; Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - S Joseph Kim
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.; Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network and Department of Medicine, University of Toronto, Toronto, Canada
| | - Nancy N Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.; Department of Surgery, St. Michael's Hospital, Toronto, Canada.; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
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Pérez-Callejo D, Torrente M, Parejo C, Laporta R, Ussetti P, Provencio M. Lung cancer in lung transplantation: incidence and outcome. Postgrad Med J 2017; 94:15-19. [DOI: 10.1136/postgradmedj-2017-134868] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/10/2017] [Accepted: 06/26/2017] [Indexed: 12/20/2022]
Abstract
IntroductionMalignancies are one of the causes of mortality after lung transplantation. However, little is known about lung cancer outcome after lung transplantation.MethodsWe performed a retrospective search of the lung transplantation database at our institution to identify patients diagnosed with lung cancer after lung transplantation.ResultsOut of 633 lung transplant patients, lung cancer was detected in 23 of them (3.63%). The most common causes for transplantation were idiopathic pulmonary fibrosis (47.8%) and emphysema (43.4%). A total of 18 patients were diagnosed during follow-up, 12 cases in the native lung (52.2%) and 6 cases in the donor lung (26.1%). The diagnosis was evidenced in the explanted lung in five patients (21.7%). The median of time from transplantation to cancer diagnosis was 39.7 months (24.356.6). Lung cancer was the cause of death in 16 patients. Survival rate at1year from diagnosis of lung cancer was 45.64% (95% CI 0.2431 to 0.6473).ConclusionsLung transplant recipients constitute a high-risk group for developing lung cancer. Among our patients, lung cancer was predominantly diagnosed in the native lung and at an advanced stage. The primary tumour was the main cause of death in most of these patients.
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Van Raemdonck D, Vos R, Yserbyt J, Decaluwe H, De Leyn P, Verleden GM. Lung cancer: a rare indication for, but frequent complication after lung transplantation. J Thorac Dis 2016; 8:S915-S924. [PMID: 27942415 DOI: 10.21037/jtd.2016.11.05] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Lung transplantation is an effective and safe therapy for carefully selected patients suffering from a variety of end-stage pulmonary diseases. Lung cancer negatively affects prognosis, particularly in patients who are no longer candidates for complete resection. Lung transplantation can be considered for carefully selected and well staged lung cancer patients with proven, lung-limited, multifocal, (minimally invasive) adenocarcinoma in situ (AIS) (previously called bronchioloalveolar cell carcinoma) causing respiratory failure. Despite a substantial risk of tumour recurrence (33-75%), lung transplantation may offer a survival benefit (50% at 5 years) with best palliation of their disease. Reports on lung transplantation for other low-grade malignancies are rare. Lung transplant candidates at higher risk for developing lung cancer [mainly previous smokers with chronic obstructive lung disease (COPD) and idiopathic pulmonary fibrosis (IPF) or older patients] should be thoroughly and repeatedly screened for lung cancer prior to listing, and preferably also during waiting list time if longer than 1 year, including the use of PET-CT scan and EBUS-assisted bronchoscopy in case of undefined, but suspicious pulmonary abnormalities. Double-lung transplantation should now replace single-lung transplantation in these high-risk patients because of a 6-9% prevalence of lung cancer developing in the remaining native lung. Patients with unexpected, early stage bronchial carcinoma in the explanted lung may have favourable survival without recurrence. Early PET-CT (at 3-6 months) following lung transplantation is advisable to detect early, subclinical disease progression. Donor lungs from (former) smokers should be well examined at retrieval. Suspicious nodules should be biopsied to avoid grafting cancer in the recipient. Close follow-up with regular visits and screening test in all recipients is needed because of the increased risk of developing a primary or secondary cancer in the allograft from either donor or recipient origin.
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Affiliation(s)
- Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
| | - Jonas Yserbyt
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
| | - Herbert Decaluwe
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Geert M Verleden
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
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Posttransplant solid organ malignancies in lung transplant recipients: a single-center experience and review of the literature. TUMORI JOURNAL 2016; 102:574-581. [PMID: 27647228 DOI: 10.5301/tj.5000557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Solid-organ tumor incidences are higher in solid organ transplant patients than in the general population. The aim of this study was to analyze solid-organ tumor frequency and characteristics in a population of lung transplant patients and provide a brief review of the literature. METHODS A retrospective analysis was conducted of all patients who underwent a lung transplant in the Lung Transplant Program at the University Hospital of Siena, Italy, from 2001 to 2014 (n = 119). Patients' demographics, pretransplant characteristics, immunosuppressive therapy, and infectious factors were recorded. RESULTS Nine patients with a median age of 59.0 years (range 50-63) of our cohort developed a solid-organ tumor (7.5%). Most of the patients experienced nonmelanoma skin cancer (44.4%); the others were diagnosed with lung cancer (22.2%), breast cancer (22.2%), and colon-rectal cancer (11.2%). The median time from transplantation to tumor diagnosis was 895.0 days (range 321-2046). No differences in pretransplant characteristics, immunosuppressive therapy, or infectious factors were found between patients who developed solid organ tumors and those who did not. CONCLUSIONS The present study confirmed that de novo malignancies are a major issue in lung transplant patients; in particular, skin and lung cancers demonstrated a higher incidence rate. Oncologic treatment of these patients is complex, requiring close collaboration between the transplant team and oncologist. Strict screening programs are key factors for an early diagnosis and to allow for prompt treatment resulting in a better outcome.
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De novo malignancy after lung transplantation in Japan. Gen Thorac Cardiovasc Surg 2016; 64:543-8. [DOI: 10.1007/s11748-016-0672-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/02/2016] [Indexed: 12/16/2022]
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Backhus LM, Mulligan MS, Ha R, Shriki JE, Mohammed TLH. Imaging in Lung Transplantation. Radiol Clin North Am 2016; 54:339-53. [DOI: 10.1016/j.rcl.2015.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Moniodis A, Racila E, Divo M. Case report: combined small cell lung cancer in a lung transplant recipient. Transplant Proc 2016; 47:852-4. [PMID: 25891746 DOI: 10.1016/j.transproceed.2015.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 01/29/2015] [Indexed: 12/22/2022]
Abstract
Lung transplantation confers an increased risk of lung cancer, especially for single lung transplant recipients, due to both the epidemiologic risk factors associated with the patient population and the posttransplantation immunosuppression required. We report what we believe to be the first case of combined small cell lung carcinoma identified in the native lung of a single lung transplant recipient. Combined small cell lung cancer is an increasingly recognized subtype of small cell carcinoma, and its possible presence is an important consideration in the interpretation of fine-needle aspiration biopsies. In our case, initial fine-needle aspiration suggested squamous cell carcinoma, and it was only after lobectomy that the diagnosis of small cell carcinoma was made. The case highlights the increased risk of malignancy in lung transplant recipients and suggests a role for adaptation of lung cancer screening guidelines to address this high-risk population.
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Affiliation(s)
- A Moniodis
- Department of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Clinics Building PBB 311, 75 Francis Street, Boston, Massachusetts, USA.
| | - E Racila
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts, USA
| | - M Divo
- Department of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Clinics Building PBB 311, 75 Francis Street, Boston, Massachusetts, USA
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Abstract
BACKGROUND Treatment-related immunosuppression in organ transplant recipients has been linked to increased incidence and risk of progression for several malignancies. Using a population-based cancer cohort, we evaluated whether organ transplantation was associated with worse prognosis in elderly patients with non-small cell lung cancer (NSCLC). METHODS Using the Surveillance, Epidemiology, and End Results Registry linked to Medicare claims, we identified 597 patients aged 65 years or older with NSCLC who had received organ transplants (kidney, liver, heart, or lung) before cancer diagnosis. These cases were compared to 114,410 untransplanted NSCLC patients. We compared overall survival (OS) by transplant status using Kaplan-Meier methods and Cox regression. To account for an increased risk of non-lung cancer death (competing risks) in transplant recipients, we used conditional probability function (CPF) analyses. Multiple CPF regression was used to evaluate lung cancer prognosis in organ transplant recipients while adjusting for confounders. RESULTS Transplant recipients presented with earlier stage lung cancer (P = 0.002) and were more likely to have squamous cell carcinoma (P = 0.02). Cox regression analyses showed that having received a non-lung organ transplant was associated with poorer OS (P < 0.05), whereas lung transplantation was associated with no difference in prognosis. After accounting for competing risks of death using CPF regression, no differences in cancer-specific survival were noted between non-lung transplant recipients and nontransplant patients. CONCLUSIONS Non-lung solid organ transplant recipients who developed NSCLC had worse OS than nontransplant recipients due to competing risks of death. Lung cancer-specific survival analyses suggest that NSCLC tumor behavior may be similar in these 2 groups.
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Lung Transplantation. PATHOLOGY OF TRANSPLANTATION 2016. [PMCID: PMC7153460 DOI: 10.1007/978-3-319-29683-8_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The therapeutic options for patients with advanced pulmonary parenchymal or vascular disorders are currently limited. Lung transplantation remains one of the few viable interventions, but on account of the insufficient donor pool only a minority of these patients actually undergo the procedure each year. Following transplantation there are a number of early and late allograft complications such as primary graft dysfunction, allograft rejection, infection, post-transplant lymphoproliferative disorder and late injury that is now classified as chronic lung allograft dysfunction. The pathologist plays an essential role in the diagnosis and classification of these myriad complications. Although the transplant procedures are performed in selected centers patients typically return to their local centers. When complications arise it is often the responsibility of the local pathologist to evaluate specimens. Therefore familiarity with the pathology of lung transplantation is important.
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Ordóñez Dios I, Montoro Ballesteros F, Vaquero Barrios J, Cobos Ceballos M, Redel Montero J, Santos Luna F. Analysis of the Incidence of Noncutaneous Neoplasia After Lung Transplantation and Its Impact on Prognosis. Transplant Proc 2015; 47:2659-60. [DOI: 10.1016/j.transproceed.2015.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 12/27/2022]
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Grewal AS, Padera RF, Boukedes S, Divo M, Rosas IO, Camp PC, Fuhlbrigge A, Goldberg H, El-Chemaly S. Prevalence and outcome of lung cancer in lung transplant recipients. Respir Med 2015; 109:427-33. [PMID: 25616348 DOI: 10.1016/j.rmed.2014.12.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/20/2014] [Accepted: 12/30/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lung transplant is the only available therapy for patients with advanced lung disease. The goal of this study was to examine the prevalence, origin, management and outcome of lung cancer in recipients of lung transplant at our institution. METHODS After institutional review board approval, we conducted a retrospective chart review of all lung transplantations in our institution from January 1990 until June 2012. RESULTS The prevalence of lung cancer in the explanted lung was 6 (1.2%) of 462 and all cases were in subjects with lung fibrosis. All 4 subjects with lymph node involvement died of causes related to the malignancy. Nine (1.9%) of 462 patients were found to have bronchogenic carcinoma after lung transplant. The most common location was in the native lung in recipients of a single lung transplant (6 out of 9 patients). In one case, the tumor originated in the allograft and was potentially donor related. The median time to diagnosis after lung transplant was 28 months with a range from 9 months to 10 years. Median survival was 8 months, with tumors involving lymph nodes or distant metastases associated with a markedly worse prognosis (median survival 7 months) than stage I disease (median survival 27 months). CONCLUSIONS The prevalence of lung cancer in lung transplant recipients is low. Using accepted donor screening criteria, donor derived malignancy is exceptionally rare. While stage I disease is associated with improved survival in this cohort, survival is still not comparable to that of the general population, likely influenced by the need for aggressive immune suppression.
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Affiliation(s)
| | | | - Steve Boukedes
- Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA
| | - Miguel Divo
- Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA
| | - Ivan O Rosas
- Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA
| | - Phillip C Camp
- Department of Thoracic Surgery Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Anne Fuhlbrigge
- Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA
| | - Hilary Goldberg
- Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA
| | - Souheil El-Chemaly
- Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA.
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