Lung Malignancy in Solid Organ Transplant Recipients: A Case Series

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Abstract

Introduction

Transplant recipients are at a higher risk for developing malignancies when compared to general population. These malignancies can be transmitted by a donor organ, can be related to the recipients’ past history of a cancer which relapses or develops de novo as a result of extensive immunosuppressive drug regimens. We aim to characterize the transplant recipients who were diagnosed with a lung malignancy over the past 10 years.

Materials and Methods

Medical records of solid organ transplant (SOT) recipients from January 2007 to November 2017, who presented with lung malignancies to our clinic were reviewed retrospectively.

Results

For the last 10 years a total of 6 SOT recipients (5 male and 1 female) with an average age of 58.6 ± 7.4 years were identified to have been diagnosed with a lung malignancy. Within these patients 4 had a liver transplant, 1 had kidney and 1 had a heart transplant history. 3 of the liver recipients had a history of hepatocellular carcinoma (HCC) and 1 patient with cholangiocellular carcinoma before transplantation, whereas the kidney and heart transplant patients had no history of cancer. Half of the patients were smokers. The median time from the transplantation to the diagnosis of lung cancer was measured as 12.5 months. 3 of the liver transplant patients who presented with multiple metastatic lesions in lung were diagnosed with metastatic carcinoma upon pathological examination of transbronchial biopsy and lobectomy material. 1 liver transplant patient who was also a heavy smoker had a diagnosis of squamous cell carcinoma 12 years post-transplant. 2 of the liver transplant patients had also acute rejection diagnosed upon liver biopsy at the same time as cancer detection. The renal transplant patient, also a smoker, had a diagnosis of small cell carcinoma, extended type with liver and bone metastasis, whereas the heart transplant patient was diagnosed with a low grade differentiated neuroendocrine type of cancer. 2 of the patients died.

Discussion

The incidence of lung cancer is shown to be especially increased in heart and lung transplant patients and related to smoking. However the incidence is also increased following other SOTS. When compared to the general population the increased incidence of lung malignancy was found to be similar to those diagnosed with HIV which reflects the critical role that chronic and prolonged immunosuppression has on lung. In our series 3 metastatic carcinomas of the primary tumor were identified pretransplant, 2 primary lung cancers related to heavy smoking and one case without previous cancer or smoking history were presented. Even though the number is low the variety shows that multiple mechanisms are responsible for increased cancer incidence in transplant patients.

Conclusion

Transplant patients, regardless of previous malignancy history or risk factors, should all be closely monitored life-long with periodic screening examinations for early malignancy detection.

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