High frequency of bronchogenic carcinoma after single-lung transplantation.
BACKGROUND
Lung transplantation is a commonly employed therapy in the treatment of patients with advanced lung diseases related to tobacco use. Little is known about the long-term incidence or risk factors for primary lung cancer after lung transplantation. To determine the frequency, clinical features and risk factors for primary bronchogenic malignancy after lung transplantation, we designed a matched cohort study of single and bilateral lung transplant recipients with extended follow-up.


METHODS
We retrospectively reviewed the records of 262 lung transplant recipients who survived > or =90 days post-transplant and assessed for the development of primary lung cancer. One hundred thirty-one consecutive single-lung transplant (SLTx) recipients were matched to 131 consecutive bilateral lung transplant (BLTx) recipients by native disease. Risk factors for lung cancer development were derived using univariate and multivariate proportional hazards models.


RESULTS
Of the SLTx recipients, 6.9% developed primary lung cancer after transplantation as compared with 0% of the BLTx recipients (p = 0.002), after a mean of 52 months. Histologically, non-small-cell cancers were present in the native lung, which led to death in 67% (6 of 9) of the patients despite treatment. Significant risk factors for the development of primary lung cancer were increasing age (p = 0.004), >60-pack-year smoking history (p = 0.03), and SLTx as compared with BLTx (p < 0.001).


CONCLUSIONS
Single-lung transplant confers a significantly elevated risk of developing primary post-transplant lung cancer as compared with BLTx in patients with comparable native disease, age and tobacco history.
Dickson
Robert P
RP
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
Davis
R Duane
RD
Rea
Jean B
JB
Palmer
Scott M
SM
D000367:Age Factors; D002283:Carcinoma, Bronchogenic / Q000209:etiology* / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000209:etiology* / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000209:etiology* / Q000473:pathology; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking; D016896:Treatment Outcome