title: Prevalence and outcome of lung cancer in lung transplant recipients.
abstract: BACKGROUND
  Lung transplant is the only available therapy for patients with advanced lung disease. The goal of this study was to examine the prevalence, origin, management and outcome of lung cancer in recipients of lung transplant at our institution.
  
  
  METHODS
  After institutional review board approval, we conducted a retrospective chart review of all lung transplantations in our institution from January 1990 until June 2012.
  
  
  RESULTS
  The prevalence of lung cancer in the explanted lung was 6 (1.2%) of 462 and all cases were in subjects with lung fibrosis. All 4 subjects with lymph node involvement died of causes related to the malignancy. Nine (1.9%) of 462 patients were found to have bronchogenic carcinoma after lung transplant. The most common location was in the native lung in recipients of a single lung transplant (6 out of 9 patients). In one case, the tumor originated in the allograft and was potentially donor related. The median time to diagnosis after lung transplant was 28 months with a range from 9 months to 10 years. Median survival was 8 months, with tumors involving lymph nodes or distant metastases associated with a markedly worse prognosis (median survival 7 months) than stage I disease (median survival 27 months).
  
  
  CONCLUSIONS
  The prevalence of lung cancer in lung transplant recipients is low. Using accepted donor screening criteria, donor derived malignancy is exceptionally rare. While stage I disease is associated with improved survival in this cohort, survival is still not comparable to that of the general population, likely influenced by the need for aggressive immune suppression.
authors.affiliation: Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Amardeep S
authors.initials: AS
authors.lastname: Grewal
authors.affiliation: Department of Pathology, Boston, MA 02115, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Padera
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Boukedes
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Divo
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA.
authors.forename: Ivan O
authors.initials: IO
authors.lastname: Rosas
authors.affiliation: Department of Thoracic Surgery Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Phillip C
authors.initials: PC
authors.lastname: Camp
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Fuhlbrigge
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA.
authors.forename: Hilary
authors.initials: H
authors.lastname: Goldberg
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Boston, MA 02115, USA. Electronic address: sel-chemaly@partners.org.
authors.forename: Souheil
authors.initials: S
authors.lastname: El-Chemaly
mesh_terms: D000328:Adult; D002283:Carcinoma, Bronchogenic / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
keywords: Cancer; Explant; Fibrosis; Lung transplant; Outcome; Post-transplant