Malignancy After Lung Transplantation: How to Manage Immunosuppression?

As newer immunosuppression has steadily induced tolerance and improved the survival time of graft, malignancy after lung transplantation has become an important cause of mortality. Cancer is the third most frequent cause of death among lung recipients who survive more than 1 year, and the oncogenic risk is believed to be directly related to the cumulative dose of immunosuppression and the drug family. Immunosuppression modification is the initial management to malignancy in transplant recipients. Adjustment of agent dosage and scheme to the minimum level where graft-organ function is still maintained is advised, although the precise modification of immunosuppression has not been studied prospectively. However, there is still no recommendation or guidelines of immunosuppression therapy scheme in lung transplant recipients after diagnosed malignancy. Some signal centers reported their experiences, but the evidence is scant because of the low quality of the available studies. It's the time to call for more high-quality data and clinical trials to explore a better immunosuppression scheme for lung transplant recipients with malignancy.