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Spies CS, Ochoa TN, Pontula A, Harris CS, Snyder LD, Pavlisko EN, Hartwig MG. With Comparable Outcomes, Should Early-Stage Lung Cancer Be a Contraindication to Lung Transplant? Ann Thorac Surg 2024; 118:261-267. [PMID: 37704001 DOI: 10.1016/j.athoracsur.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/27/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Active primary lung malignancy remains a strong contraindication to lung transplantation (LTx). However, outcomes are unclear for patients with early-stage non-small cell lung cancer (NSCLC) who undergo LTx. We hypothesize that patients with early-stage NSCLC incidentally discovered in the explanted lungs have survival comparable to LTx recipients without incidental cancer identified. METHODS We performed a single-center retrospective analysis of all LTx recipients from May 2007 to September 2021 with incidental cancer identified in the explanted lungs by pathologist report. Survival statistics were estimated using Kaplan-Meier analysis. RESULTS Of the 1586 LTx performed, 23 patients (1.5%) were found to have incidental lung cancer in the explanted lungs. The most common indications for LTx were interstitial lung disease (n = 13) and chronic obstructive pulmonary disease (n = 7), and the most common histologic diagnosis was adenocarcinoma (n = 14). In the cohort with stage I disease (n = 9), the 1- and 5-year unadjusted Kaplan-Meier survival rates were 88.9% and 51.9%, respectively. The 1- and 5-year survival rates for transplant recipients without incidental cancer findings at LTx during this period were 86.7% and 59.4%, respectively, and did not differ significantly between the 2 strata (P = .96). CONCLUSIONS Survival rates at 1 and 5 years were comparable between LTx recipients with incidentally noted pathologic stage I NSCLC and contemporary recipients without cancer. All cancer-related deaths occurred in recipients with incidentally noted advanced NSCLC. These results suggest that patients with pathologic stage I lung cancer at the time of transplant have outcomes comparable to those without cancer findings at the time of transplant.
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Affiliation(s)
- Connor S Spies
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Arya Pontula
- Faculty of Biology, Medicine, and Health, School of Medicine, University of Manchester, Manchester, United Kingdom; Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Laurie D Snyder
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Matthew G Hartwig
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
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2
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Jablonski R. Lung Cancer and Lung Transplantation. CURRENT PULMONOLOGY REPORTS 2023. [DOI: 10.1007/s13665-023-00301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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3
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Razia D, Arjuna A, Trahan A, Hahn MF, Abdelrazek H, Omar A, Tokman S, Hashimi AS, Huang J, Smith MA, Bremner RM, Walia R. Incidentally Detected Malignancies in Lung Explants. Prog Transplant 2022; 32:332-339. [PMID: 36069063 DOI: 10.1177/15269248221122876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Incidentally detected malignancies in lung explants portend risk of early cancer recurrence and metastases with posttransplant immunosuppression. We present a series of lung transplant recipients with previously unverified malignancies in native lung explants. Design: We reviewed the histopathology, radiographic imaging, and management of lung explant malignancies at our institution over 10 years (2011-2020). Endpoints were survival and allograft rejection. Results: An explant malignancy was found in 1.3% (11/855) of lung transplant recipients (6 [55%] men; median age 68 years; 6 [55%] ex-smokers [median pack-years, 25]). Nine (82%) were adenocarcinoma, 1 (9%) was squamous cell carcinoma (SCC), and 1 (9%) was follicular lymphoma. Three patients (27%) had multifocal involvement (≥3 lobes), 4 (36%) had nodal involvement, and the median (range) tumor size was 2.7 (0.4-19) cm. The median interval between last imaging and transplant was 58 (29-144) days. Mycophenolate mofetil was discontinued or reduced in all; everolimus was used in 2 patients, and cisplatin-pemetrexed chemotherapy was used in 2 patients. The prevalence of acute cellular rejection and chronic rejection was 27% and 9%, respectively. Lung recipients with cancer had significantly lower survival than those without (36.4% vs 67.3%, p = 0.002); median survival was 27 (17, 65) months in 4 recipients who were alive and cancer-free at the end of the study period. Conclusions: Unidentified malignancies, commonly adenocarcinoma, can be detected in explanted native lungs. Pneumonectomy may be curative in SCC, lymphoproliferative disorders, and stage I adenocarcinoma. Modulating immunosuppression to prevent allograft rejection and tumor proliferation is warranted.
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Affiliation(s)
- Deepika Razia
- Pulmonary and Lung Transplantation Division, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.,Creighton University School of Medicine- Phoenix Campus, Phoenix, Arizona, USA
| | - Ashwini Arjuna
- Pulmonary and Lung Transplantation Division, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.,Creighton University School of Medicine- Phoenix Campus, Phoenix, Arizona, USA
| | - Amy Trahan
- Creighton University School of Medicine- Phoenix Campus, Phoenix, Arizona, USA.,Radiology Division, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mary F Hahn
- Creighton University School of Medicine- Phoenix Campus, Phoenix, Arizona, USA.,Pathology Division, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Hesham Abdelrazek
- Pulmonary and Lung Transplantation Division, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.,Creighton University School of Medicine- Phoenix Campus, Phoenix, Arizona, USA
| | - Ashraf Omar
- Pulmonary and Lung Transplantation Division, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.,Creighton University School of Medicine- Phoenix Campus, Phoenix, Arizona, USA
| | - Sofya Tokman
- Pulmonary and Lung Transplantation Division, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.,Creighton University School of Medicine- Phoenix Campus, Phoenix, Arizona, USA
| | - Abdul Samad Hashimi
- Creighton University School of Medicine- Phoenix Campus, Phoenix, Arizona, USA.,Thoracic Surgery and Lung Transplantation Division, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jasmine Huang
- Creighton University School of Medicine- Phoenix Campus, Phoenix, Arizona, USA.,Thoracic Surgery and Lung Transplantation Division, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael A Smith
- Creighton University School of Medicine- Phoenix Campus, Phoenix, Arizona, USA.,Thoracic Surgery and Lung Transplantation Division, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ross M Bremner
- Creighton University School of Medicine- Phoenix Campus, Phoenix, Arizona, USA.,Thoracic Surgery and Lung Transplantation Division, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Rajat Walia
- Pulmonary and Lung Transplantation Division, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.,Creighton University School of Medicine- Phoenix Campus, Phoenix, Arizona, USA
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4
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Turkkan S, Basaran FC, Sahin MF, Beyoglu MA, Yilmaz E, Ozay HY, Bindal M, Yazicioglu A, Yekeler E. Everolimus Use in Lung Transplant Recipients. Transplant Proc 2022; 54:2317-2324. [PMID: 36192210 DOI: 10.1016/j.transproceed.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/09/2022] [Accepted: 08/26/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Most lung transplantation centers prefer triple immunosuppressive therapy with tacrolimus, mycophenolate mofetil, and corticosteroids. However, to prevent complications and comorbidities caused by tacrolimus, replacing the drug with everolimus has been considered. METHODS This is a retrospective observational study investigating everolimus switch for different reasons. The population was divided into 3 groups: chronic lung allograft dysfunction (CLAD), kidney impairment, and malignant neoplasm groups. We investigated whether we achieved the goal of the switch and the frequency of rejection, cytomegalovirus and fungal infections, and everolimus adverse effects. RESULTS Nineteen patients received everolimus therapy, and 5 of these were for CLAD, 7 for tacrolimus nephrotoxicity, and 7 for explant/de novo malignant neoplasm. The patients were followed up for a mean (SD) of 30 (16.7) months under the therapy. The number of acute cellular rejection, cytomegalovirus infection, and aspergillosis infection cases before switch were 7, 13, and 2, respectively, and 7, 2, and 3 after that. The mean values of creatinine and estimated glomerular filtration rate of the whole population after the switch improved with no statistical significance, whereas it was significant in tacrolimus nephrotoxicity group. Three patients in the CLAD group remained stable after switching, whereas 2 progressed. Only 1 of the 7 patients with malignant neoplasms had a recurrence during 31.1 (16.5) months of median follow-up. Eleven cases of everolimus adverse effects occurred in 9 patients (47.3%), with 2 (10.5%) withdrawal events. Kidney impairment (P = .02) and age (P = .05) stood out as significant risk factors for drug adverse effects. CONCLUSIONS After lung transplant, everolimus can be a safe alternative for immunosuppression with acceptable adverse effects.
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Affiliation(s)
- Sinan Turkkan
- Department of Thoracic Surgery and Lung Transplantation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
| | - Fatmanur Celik Basaran
- Department of Thoracic Surgery and Lung Transplantation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Furkan Sahin
- Department of Thoracic Surgery and Lung Transplantation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Muhammet Ali Beyoglu
- Department of Thoracic Surgery and Lung Transplantation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Emre Yilmaz
- Department of Thoracic Surgery and Lung Transplantation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Hülya Yigit Ozay
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Mustafa Bindal
- Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Alkin Yazicioglu
- Department of Thoracic Surgery and Lung Transplantation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Erdal Yekeler
- Department of Thoracic Surgery and Lung Transplantation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Mondoñedo JR, Huang T, Lin J, Wakeam E. Explanted malignancies after lung transplantation: the University of Michigan experience. Interact Cardiovasc Thorac Surg 2022; 35:6649748. [PMID: 35877066 PMCID: PMC9341308 DOI: 10.1093/icvts/ivac203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 07/01/2022] [Accepted: 07/23/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
The management of patients with an explanted malignancy after lung transplantation is not well understood. We reviewed our institutional experience and outcomes at a single academic medical centre between December 1997 and April 2021 for patients with malignancies of all histologic types identified on explant pathology. Primary lung cancers were reclassified using the 8th Edition TNM staging and the 2021 World Health Organization histologic classification of lung cancers. Of the 733 patients undergoing lung transplantation, 15 (2.05%) were found to have malignancy on the explanted lungs, including 6 (0.82%) primary lung cancers. Four patients were found to have early-stage lung cancers, while 2 patients had advanced-stage IV disease. Survival ranged from 0 to 109 months for the entire cohort with median 23.2 [49.9] months in those with primary lung cancers. There were 2 recurrences following explanted stage I (15 months) and stage IV (53 months) diseases. Other explant pathologies included carcinoid tumourlets in 6 patients, lymphoma in 2 and metastatic leiomyosarcoma in 1. In conclusion, explanted lung malignancies are an infrequent but significant finding on explant pathology. Further data are needed to better characterize and stratify this patient cohort.
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Affiliation(s)
- Jarred R Mondoñedo
- Section of Thoracic Surgery, Department of Surgery, University of Michigan , Ann Arbor, MI, USA
| | - Tao Huang
- Department of Pathology, University of Michigan , Ann Arbor, MI, USA
| | - Jules Lin
- Section of Thoracic Surgery, Department of Surgery, University of Michigan , Ann Arbor, MI, USA
| | - Elliot Wakeam
- Section of Thoracic Surgery, Department of Surgery, University of Michigan , Ann Arbor, MI, USA
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Dharia A, Boulet J, Sridhar VS, Kitchlu A. Cancer Screening in Solid Organ Transplant Recipients: A Focus on Screening Liver, Lung, and Kidney Recipients for Cancers Related to the Transplanted Organ. Transplantation 2022; 106:e64-e65. [PMID: 33795594 DOI: 10.1097/tp.0000000000003773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the last few decades, the life expectancy of solid organ transplant recipients (SOTRs) has improved significantly. With SOTRs living longer, more recipients are dying from cancer. There is a reported 2- to 3-fold increased risk of cancer-specific mortality in SOTRs compared with the general population. Cancer in an SOTR can be de novo, recurrent, or donor-derived. Cancer screening in this population is crucial, as early detection and treatment may improve outcomes. In the absence of randomized controlled trials dedicated to SOTRs, clinicians rely on clinical practice guidelines from regional and national transplant societies; however, these may vary considerably across jurisdictions and transplanted organ. At present, no widely accepted consensus exists for cancer screening protocols in SOTRs, particularly with regard to screening for malignancy related to transplanted organ. Some SOTRs may be at higher risk of malignancies within the allograft. This is particularly the case in lung and liver recipients, though less common in kidney recipients who are at increased risk of developing renal cell cancer in their native kidneys. This increased risk has not been uniformly incorporated into screening recommendations for SOTRs. In this review, we summarize the cancer screening recommendations for SOTRs from various transplant organizations based on transplanted organ. This review also discusses the complexity and controversies surrounding screening of cancer in the allograft and future avenues to improve cancer detection in this context. More studies specific to SOTRs are required to form generalizable and evidence-based cancer screening guidelines, particularly with respect to cancer screening in the allograft.
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Affiliation(s)
- Atit Dharia
- Division of Nephrology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Jacinthe Boulet
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, Montreal, QC, Canada
| | - Vikas S Sridhar
- Division of Nephrology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Abhijat Kitchlu
- Division of Nephrology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada
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7
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Peng G, Yang C, Liu M, Cui W, Grande B, Kao C, Solli P, Makdisi G, Xu X, He J. Pulmonary fibrosis combined with lung cancer following lung transplantation: should we do more? Transl Lung Cancer Res 2021; 10:1588-1593. [PMID: 33889533 PMCID: PMC8044479 DOI: 10.21037/tlcr-21-46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Currently, lung transplantation is the standard of care for patients with end-stage lung disease, with interstitial lung disease (ILD) being the most common reason in the recent years In the other hand, in cases where stage II and III lung cancer have been identified following lung transplantation, long-term survival outcomes are poor when compared to lung cancer patients that have not received a lung transplant because the use of immunosuppressant and the problem of rejection and infection and the treatment of recurrence and so on. However, there is no statistical difference observed in stage I (pT1N0M0) patients. In this paper we report about a patient with ILD receiving left lung transplantation in the early time. A lesion of the right lung which was considered the normal ILD tissue and without enough attention. Post-transplant it showed progress and finally the whole right lung (native lung) was occupied by the tumor. Some ground glass changes could also be found in the transplanted lung several months later. A secondary lung transplant was performed for this patient, and there has been no postoperative recurrence thus far. For lung transplant patients with high-risk factors, effective surveillance methods are required for the early detection of lung cancer.
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Affiliation(s)
- Guilin Peng
- Department of Thoracic Surgery and Organ Transplantation, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chao Yang
- Department of Thoracic Surgery and Organ Transplantation, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mengyang Liu
- Department of Thoracic Surgery and Organ Transplantation, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weixue Cui
- Department of Thoracic Surgery and Organ Transplantation, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bastian Grande
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Christina Kao
- Section of Pulmonary, Critical Care, and Sleep, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Piergiorgio Solli
- Department of Cardio-Thoracic Surgery and Hearth & Lung Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - George Makdisi
- Division of Cardiothoracic Surgery, University of South Florida, Tampa General Hospital, Tampa, FL, USA
| | - Xin Xu
- Department of Thoracic Surgery and Organ Transplantation, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Organ Transplantation, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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8
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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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9
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Silva SC, Murinello N, Alfarroba S, Santos AS, Calvinho P, Semedo L. Lung transplant complicated with unexpected neoplasm in explanted lungs: A difficult challenge to manage. Pulmonology 2019; 26:172-174. [PMID: 31732438 DOI: 10.1016/j.pulmoe.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- S C Silva
- Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.
| | - N Murinello
- Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - S Alfarroba
- Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - A S Santos
- Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - P Calvinho
- Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - L Semedo
- Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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10
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Incidentally Detected Malignancies in Lung Transplant Explants. Transplant Direct 2019; 5:e503. [PMID: 31773056 PMCID: PMC6831122 DOI: 10.1097/txd.0000000000000947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 11/26/2022] Open
Abstract
Active malignancy diagnosed within 5 years is an absolute contraindication for lung transplantation. In this study, we evaluated the rate of incidental malignancies detected in explanted lungs at our institution and assessed the posttransplant survival in patients with nonsmall cell lung cancer (NSCLC). Methods A retrospective chart review of lung transplant recipients at our institution from February 1999 to June 2017 was conducted. A literature review was performed to evaluate the prevalence and survival outcomes in patients with unexpected malignancies. Results From 407 patients who underwent lung transplantation, 9 (2.2%) were discovered to have malignant neoplasms. There were 3 cases of adenocarcinoma, 3 cases of adenocarcinoma in situ, 2 cases of squamous cell carcinoma, and 1 case of metastatic renal cell carcinoma. An extensive literature review found 12 case reports or case series reporting malignancy discovered at the time of lung transplantation. The overall prevalence of incidental neoplasms among 6746 recipients is around 1.5% (n = 103). The most common neoplasms discovered included adenocarcinoma (n = 56, 54%) and squamous cell carcinoma (n = 29, 28%). The overall 3-year survival was 54.4% for patients with localized NSCLC compared to 5.7% for those with nonlocalized disease. Conclusions Unidentified malignancies occur despite aggressive radiographic surveillance with poor posttransplant outcomes in patients with advanced malignancy. Malignancy-related radiographic findings may be missed pretransplant secondary to architectural distortion of lung parenchyma related to end-stage lung disease or because of the critical timing of surgery when donor lungs are available.
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11
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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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12
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Patterns of Recurrence and Overall Survival in Incidental Lung Cancer in Explanted Lungs. Ann Thorac Surg 2018; 107:891-896. [PMID: 30391248 DOI: 10.1016/j.athoracsur.2018.09.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 08/16/2018] [Accepted: 09/07/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recurrence and overall survival for incidental lung cancer in explanted lungs vary between different series. Recurrence patterns are also not well described. The primary objective of this study is to study the recurrence patterns and time to recurrence for various stages of lung cancer in lung transplant recipients. METHODS A retrospective review of our institutional database was performed to identify patients who had incidental lung cancer found in transplant pneumonectomy specimens from 1990 to 2017. Demographic, radiographic, and perioperative clinical variables were collected. Time to recurrence, overall survival, and recurrence patterns were recorded. Freedom from recurrence and overall survival were estimated by using Kaplan-Meier analysis. RESULTS Thirty-one patients had unexpected malignancy and 29 patients (1.6%) had primary lung carcinoma in the explanted lung. Indication for transplantation was chronic obstructive pulmonary disease in 15 patients (48%) and interstitial lung disease for 16 patients (52%). Preoperative imaging showed indeterminate nodules in 10 patients (32%). Pathologic review showed stage I disease in 15 patients (54%), stage II disease in 10 patients (35%), and stage III disease in 2 patients (7%). Recurrence was noted in 8 patients (28%). Most patients had nodal disease (25%) or systemic recurrence (75%). All recurrences occurred within 2 years of the transplantation. For patients with stage I and II disease, freedom from recurrence at 1, 3, and 5 years was 91%, 55%, and 55%, respectively. Overall survival at 1, 3, and 5 years was 78%, 18%, and 14%, respectively. CONCLUSIONS Most recurrences occur within 2 years after transplantation and are the cause of death in these patients. Patients with nodal disease tend to have higher recurrence rates. Multidisciplinary review of abnormal radiographic findings before transplantation and close follow-up may allow for detection of undiagnosed cancers.
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13
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Lung transplantation for non-small cell lung cancer and multifocal bronchioalveolar cell carcinoma. Lancet Oncol 2018; 19:e351-e358. [DOI: 10.1016/s1470-2045(18)30297-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/06/2018] [Accepted: 04/09/2018] [Indexed: 12/14/2022]
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14
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Patil PD, Sultan S, Hahn MF, Roy SB, Ross MD, Abdelrazek H, Bremner RM, Thawani N, Walia R, Panchabhai TS. Incidental extensive adenocarcinoma in lungs explanted from a transplant recipient with an idiopathic pulmonary fibrosis flare-up: A clinical dilemma. Respir Med Case Rep 2018; 25:45-48. [PMID: 29942737 PMCID: PMC6011045 DOI: 10.1016/j.rmcr.2018.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 01/06/2023] Open
Abstract
Patients under consideration for lung transplantation as treatment for end-stage lung diseases such as idiopathic pulmonary fibrosis (IPF) often have risk factors such as a history of smoking or concomitant emphysema, both of which can predispose the patient to lung cancer. In fact, IPF itself increases the risk of lung cancer development by 6.8% to 20%. Solid organ malignancy (non-skin) is an established contraindication for lung transplantation. We encountered a clinical dilemma in a patient who presented with an IPF flare-up and underwent urgent evaluation for lung transplantation. After transplant, the patient's explanted lungs showed extensive adenocarcinoma in situ, with the foci of invasion and metastatic adenocarcinoma in N1-level lymph nodes, as well as usual interstitial pneumonia. Retrospectively, we saw no evidence to suggest malignancy in addition to the IPF flare-up. Clinical diagnostic dilemmas such as this emphasize the need for new noninvasive testing that would facilitate malignancy diagnosis in patients too sick to undergo invasive tissue biopsy for diagnosis. Careful pathological examination of explanted lungs in patients with IPF is critical, as it can majorly influence immunosuppressive regimens, surveillance imaging, and overall prognosis after lung transplant.
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Affiliation(s)
- Pradnya D. Patil
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir Sultan
- Department of Pulmonary and Critical Care Medicine, University of Arizona College of Medicine, Banner University Medical Center, Phoenix, AZ, USA
| | - M. Frances Hahn
- Department of Pathology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Sreeja Biswas Roy
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Mitchell D. Ross
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Hesham Abdelrazek
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Ross M. Bremner
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Nitika Thawani
- Department of Radiation Oncology, University of Arizona Cancer Center at St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Rajat Walia
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Tanmay S. Panchabhai
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
- Corresponding author. Department of Pulmonology, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Rd., Suite 500, Phoenix, AZ 85013, USA.
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15
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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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16
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Unexpected Neoplasms in Lungs Explanted From Lung Transplant Recipients: A Single-Center Experience and Review of Literature. Transplant Proc 2018; 50:234-240. [DOI: 10.1016/j.transproceed.2017.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/13/2017] [Indexed: 01/20/2023]
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17
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Berastegui C, LaPorta R, López-Meseguer M, Romero L, Gómez-Ollés S, Riera J, Monforte V, Sáez B, Bravo C, Roman A, Ussetti P. Epidemiology and Risk Factors for Cancer After Lung Transplantation. Transplant Proc 2017; 49:2285-2291. [DOI: 10.1016/j.transproceed.2017.09.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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18
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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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19
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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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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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21
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Van Raemdonck DEM. Editorial Commentary: A New Set of Lungs or a New Pair of Glasses? Semin Thorac Cardiovasc Surg 2015; 27:15-6. [PMID: 26074104 DOI: 10.1053/j.semtcvs.2015.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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Nakajima T, Cypel M, de Perrot M, Pierre A, Waddell T, Singer L, Roberts H, Keshavjee S, Yasufuku K. Retrospective Analysis of Lung Transplant Recipients Found to Have Unexpected Lung Cancer in Explanted Lungs. Semin Thorac Cardiovasc Surg 2015; 27:9-14. [DOI: 10.1053/j.semtcvs.2015.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 12/26/2022]
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23
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Olland AB, Falcoz PE, Santelmo N, Kessler R, Massard G. Primary Lung Cancer in Lung Transplant Recipients. Ann Thorac Surg 2014; 98:362-71. [DOI: 10.1016/j.athoracsur.2014.04.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/27/2014] [Accepted: 04/01/2014] [Indexed: 02/03/2023]
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