Incidence of malignancies after lung transplantation and their effect on the outcome. 26 years' experience

Konstantina Spetsotaki; Achim Koch; Christian Taube; Dirk Theegarten; Markus Kamler; Nikolaus Pizanis

doi:10.1016/j.heliyon.2023.e20592

Incidence of malignancies after lung transplantation and their effect on the outcome. 26 years' experience

Heliyon. 2023 Sep 30;9(10):e20592. doi: 10.1016/j.heliyon.2023.e20592. eCollection 2023 Oct.

Authors

Konstantina Spetsotaki¹, Achim Koch¹, Christian Taube², Dirk Theegarten³, Markus Kamler¹, Nikolaus Pizanis¹

Affiliations

¹ Department of Thoracic Transplantation and Assist Devices, Cardiothoracic Surgery, West German Heart and Vascular Center, University Hospital Essen, Germany.
² Department of Pneumology, Ruhrland Clinic, University Hospital Essen, Germany.
³ Institute of Pathology, University Hospital Essen, Germany.

Abstract

Background: Malignancy is a significant, life-limiting complication after lung transplantation (LuTx) and the second common long-term cause of death. We aimed to investigate its incidence and effect on the outcome.

Methods: This is a retrospective observational study. Between 1996 and 2022, n = 627 lung transplantations (LuTx) were performed in our department. We used our institutional database to identify recipients with malignancies after LuTx and examined the malignancies' incidence and mortality.

Results: N = 59 malignancies occurred in n = 55 (8.8%) LuTx recipients. The post-LTx malignancies incidence was 9.4% (59/627). We report the following rates based on their location: n = 17/55 (28,8% of all recipients diagnosed with malignancies) skin, n = 10/55 (16,95%) gastrointestinal, n = 9/55 (15,3%) respiratory, n = 5/55 (8,48%) lymphatic, n = 13/55 (23,6%) other, n = 5 (8,48%) multiple synchronous.During this study period, a total of n = 328 deaths after LuTx was determined. N = 29 (8,84% of all deaths) were malignancy induced, corresponding to a total malignancy-induced mortality of 4.6% (n = 29/627). The majority of deaths were attributed to GI adenocarcinoma and PTLD. Malignancies' origin, primary COPD diagnosis, type, and specific age group were significantly survival-related (p-values <0.05). The most affected organ was skin and showed the best prognosis. PTLD had the fastest and pancreatic the latest onset.

Conclusions: This is the first report of its kind in a large cohort of german LuTx recipients. The prevalence ranking of the three commonest malignancy were skin > colorectal > PTLD. Post-LTx malignancy was the second commonest cause of death. Further studies are needed, while post-LuTx malignomas remain a serious impairment of long-term LuTx survival.

Keywords: Lung recipient; Lung transplant; Lung transplantation; Malignancies; Patient survival.