Many pre-lung transplant recipients with end-stage lung disease are at high risk for lung cancer. Evidence of lung cancer has been considered a contraindication to lung transplantation mainly because of the risk of dissemination secondary to immunosuppression post transplant. Experience is therefore limited on how patients with carcinoma progress post transplantation. The purpose of this study was to assess the frequency and spectrum of lung cancer found incidently at time of pneumonectomy for transplantation at our center.
We reviewed the charts of all lung transplant recipients at the University of Texas Health Science Center, San Antonio. Patient demographics including age, sex, indication for transplant, and smoking history were collected. Explant pathologic reports and pre-transplant radiographic studies were evaluated.
There was 232 lung transplants performed on 229 patients from 11/1987 to 4/2005 (37 bilateral and 196 single). There were 120 males and 109 females. Mean age at time of transplant was 50 years. Five recipients (2.2%) were found to have carcinoma in the explanted lung. A significant increase in the proportion of smokers and women in the recipients with carcinoma was found. There was no radiographic evidence of possible neoplasm on CT Scan within 6 months prior to transplant or on chest radiograph on the day of transplantation. See Table 1.
Discovering previously undetected neoplasms in the explanted lung of transplant recipients is an uncommon phenomenon. Although many recipients listed for transplantation are at high risk for lung cancer (diagnoses of emphysema and usual interstitial pneumonitis), those at highest risk are those who also have a significant smoking history.
Patients listed for lung transplantation often wait for greater then two years for a graft. The evaluation including chest radiographs and CT scans are often performed prior to or at the time of listing. In patients who are at highest risk for developing primary lung carcinomas, repeat CT scan screening should be considered shortly before transplantation.
Data of Five Lung Transplant Recipients With Undetected Lung CarcinomaCaseAge/SexIndication for TransplantationSmoking HistoryType of NeoplasmGrade of NeoplasmPre-Transplant CXR CT Scan 6 months Prior to TransplantationSurvival Post Transplantation160 MEmphysemaYesAdenocarcinoma (poorly differentiated)Stage 1NegativeDead -14 months243 FEmphysemaYesAdenocarcinomaStage 1NegativeDead-36 months353 FEmphysemaYesBronchoalveolar CarcinomaStage 1NegativeDead-4 months459 FUIPYesSmall Cell CarcinomaStage 1NegativeDead-1 day545 Fα-one anti-trypsinYesAdenocarcinoma (Invasive)Stage 1NegativeAlive - 32 months
Deborah Levine, None.