3．慢性期移植肺機能不全と悪性腫瘍：肺移植後悪性腫瘍発症例の検討

Patients after lung transplantation are at risk for postoperative malignancy mainly due to postoperative immunosuppression. Skin cancer and post-transplant lymphoproliferative disorder （PTLD） are common in Western countries. We retrospectively reviewed the medical records of 120 patients undergoing lung transplantation between April 2002 and July 2015 at Kyoto University. Postoperative malignancy developed in 14 patients（11.7％）：PTLD in 8, gastric cancer in 2, breast cancer in 1, glioblastoma in 1, lung cancer in 1, and adenocarcinoma of unknown primary in 1. Seven patients（11.3％）and 7 patients （12.1％）were after living-donor lung transplantation（ LDLLT） and cadaveric lung transplantation （CLT）, respectively （p＝1.00）. The overall 5-year survival of patients with postoperative malignancy was 39.3％， which tended to be worse （p＝0.059）， compared to those without postoperative malignancy（71.4％）. All postoperative malignancies were de novo malignancies without any recurrence of original malignancies. Postoperative malignancies occurred after LDLLT as well as after CLT, and seemed to have a negative impact on long-term outcome of lung transplant recipients. The majority was PTLD；however, skin cancer was not recognized, suggesting ethnic differences. We should be careful about postoperative malignancies in follow-up of the lung transplant recipients.