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Incidentally Detected Malignancies in Lung Transplant Explants
Dhruv A Amratia1,2, William R Hunt2,3, David Neujahr2,3
1Department of Medicine, Emory University, Atlanta, GA.
Transplantation Direct
|November 28, 2019
Summary
Incidental malignancies are found in 2.2% of lung transplant recipients. Early-stage nonsmall cell lung cancer (NSCLC) offers better survival, but advanced disease leads to poor outcomes post-transplant.
Area of Science:
- Thoracic surgery
- Transplant oncology
- Pulmonary medicine
Background:
- Active malignancy is a contraindication for lung transplantation.
- Incidental cancers in explanted lungs pose a challenge.
Purpose of the Study:
- Evaluate the rate of incidental malignancies in explanted lungs.
- Assess post-transplant survival in patients with nonsmall cell lung cancer (NSCLC).
Main Methods:
- Retrospective chart review of lung transplant recipients (1999-2017).
- Literature review on unexpected malignancies in transplant patients.
Main Results:
- 9/407 (2.2%) recipients had incidental neoplasms.
- Adenocarcinoma and squamous cell carcinoma were most common.
- 3-year survival: 54.4% for localized NSCLC vs. 5.7% for nonlocalized.
Conclusions:
- Malignancies are missed pre-transplant despite surveillance.
- Advanced NSCLC significantly impacts post-transplant survival.
- Architectural distortion and surgical timing can obscure findings.
