Development of neoplasms during lung transplantation follow-up

Lung transplant patient survival has significantly improved over the last 2 decades, which has resulted in an increased incidence of malignant disease. We undertook a descriptive, retrospective study of our series of transplant patients.

The study included 129 transplantations from 1999 to 2006. Ten patients (7.75%) developed 11 neoplastic processes during the follow-up period.

In these 10 patients with neoformative processes (group 1), 40% were male and 60% female, compared with 62% male and 38% female in the neoplasia-free group (group 2). The overall mean age was 50.5 +/- 15.4 years in group 1 and 48 +/- 14 years in group 2. The neoplasias were: lymphomas (2) and tumors in the urinary tract (2), colon (2), kidney (1), skin (2), breast (1), and native lung (1). The median time from organ transplantation to diagnosis was 21 +/- 16 months. Of the 10 patients in group 1, 60% died, within a median of 9 months after diagnosis. Treatment consisted of surgery in 4 patients, chemotherapy in 5, and chemoradiotherapy in 1. The immunosuppression was changed after cancer diagnosis in 30% of the patients.

Pharmacological immunomodulation caused a higher incidence of malignant disease, in addition to a worse prognosis for these diseases, which demonstrated the importance of adjusting the dose and searching for adequate therapeutic combinations.