Risk of Malignancy after Lung Transplantation: A Single Center Experience

PURPOSE Although malignancy is considered a common complication after lung transplantation, profound studies about incidence, characterization, risk assessment and morbidity and mortality are scarce. Therefore we analyze all recipients at our center. METHODS All 521 lung transplant recipients at our center between 1992 and 2018 were retrospectively assessed for pre-transplant history and post-transplant onset of malignoma (censor date 01.05.2019). The incidence of occurrence was analyzed using Kaplan-Meier survival. Risk factors to develop a malignoma were assessed by multiple Cox-regression. RESULTS During the observation period, 3.1% (N=16) recipients were transplanted with a history of a cured malignoma, not reoccurring within at least 5 years. After transplantation, 3.1% (N=16) recipient developed a lymphoma, 22.1% (N=115) developed skin cancer and 11.7% (N=63) a non-skin-malignoma. Within non-skin-malignomas, gastrointestinal carcinomas (41.3%, N=26) and lung carcinomas (15.9%, N=10) were the predominant groups. Of note, 6 out of 10 lung carcinomas originated from the donor lung. 6.9% (N=36) of the recipients died of malignoma, accounting for 10.8% of all observed deaths (N=333). The incidence of non-skin-malignancies was after 1 year 2.4%, after 5 years 10.5% and after 10 years 24.4%. The incidence of skin cancer was at 1 year 1.8%, at 5 years 16.3% and at 10 years 35.8%. Multiple Cox-regression revealed that age ≥ 50 years (HR2.8; 95%CI 1.7-4.6) and the underlying diseases of emphysema (HR2.9; 95%CI 1.7-4.9) and interstitial pulmonary fibrosis (HR2.5; 95%CI 1.4-4.6) were independent risk factors to develop a non-skin-maligonoma. CONCLUSION Post-transplant malignancies are an important reason for morbidity and mortality in lung transplantation. Screening for malignancies during follow up is crucial, especially when considering the increasing risk by the current trend toward an older recipient population, underlying diseases with a smoking history as well as extended donor lungs.