Incidence, outcomes and risk factors for neoplasms in explanted lungs

The detection of a cancer in a potential recipient is an absolute contraindication for lung transplantation. However, there is a small proportion of unexpected neoplasms in lung explants. It seems that risk factors for neoplasms in explant could be a long period between computed tomographic scan and transplantation, COPD, idiopathic pulmonary fibrosis (IPF), and tobacco exposure. The aims of our study were to review our institution9s incidence and outcomes of malignancies found in lung explants and to identify risk factors for neoplasms in explants. 132 consecutive lung transplants files were collected from Bordeaux University9s transplant center, from 2008 to 2015. Intergroup comparisons were performed using the Mann-Whitney U test for continuous variables and the Fisher exact test for categorical variables. 5 neoplasms (adenocarcinomas) were found among the 132 lung explants, representing a 3.8% incidence. 4 of 5 were detected at an early stage (stage IA) of which 2 in the setting of emphysema and 2 in the setting of fibrosis interstitial disease (1 IPF and 1 systemic sclerosis): no recurrence was found. 1 of 5 neoplasms was detected at an advanced stage (stage IV) in the setting of IPF and recurrence occurred 6 months after transplantation. Incidence of unexpected cancer was higher (p Fibrosis lung diseases, particularly IPF seem to be risk factors for undetected neoplasms in lung explants. Efforts to improve screening in these populations seem needed.