39 - Freie Mitteilung
Clinical works I
16. Mai 2019, 08:30 - 10:00, Bellavista 2, 6. OG
Outcome of incidental and secondary bronchogenic carcinoma following lung transplantation
C. Forster, A. Koutsokera, J. D. Aubert, M. Gonzalez, T. Krueger, J. Y. Perentes, E. Abdelnour-Berchtold, Presenter: C. Forster (Lausanne)
International registries report an overall incidence of 4% of lung cancer in recipients after lung transplantation. Most concern single lung transplant with past smoking history, idiopathic pulmonary fibrosis or COPD. These patients with poor prognosis develop malignancy in their remaining native lungs. However, bronchogenic carcinoma in the transplanted allograft is rare and little is known about double-lung transplant series paired to their donor lung characteristics.
A retrospective single institution experience based on all patients undergoing lung transplantation between January 2004 and December 2018. All recipients with (group 2) and without (group 1) lung cancer were identified. Two subgroups were then defined according to unforeseen tumors discovered on the explanted lungs (group 2a) or to those that developed de novo on the allograft (group 2b). Kaplan-Meier curves, demographic and pairwise tests were computed depending on the dataset.
From all 257 patients, 95% (n=244) underwent a double-lung transplant procedure. Out of the 16 patients diagnosed with lung cancer, nine were incidental findings on the explanted lung (group 2a) and seven had secondary malignancy (group 2b). Survival was significantly lower in group 2b (p<0.05) (figure 1) and mean time interval between transplant and diagnosis was 65.3 months. Mean age of donors was 48.2+/-16 years in group 1 and 60.4+/-6.8 in group 2b (p<0.001). The donor’s smoking history was similar in both groups (46.3% in group 1 versus 42.9% in group 2b). Mean age of recipients at transplantation was 47.9+/-14 years in group 1, 55.7+/-6.7 in group 2a (p<0.05) and 61+/-4.2 in group 2b (p<0.05).
We conclude that the age of both donors and recipients is a risk factor for lung cancer in transplant recipients whereas neither the donor’s smoking status nor the recipient’s primary diagnosis is associated with this complication. Overall, a diagnosis of lung cancer has a poor prognosis in this population.