Incidence of Carcinoma in the Native Lung After Single Lung Transplantation

This study aims to assess the incidence of primary lung cancer in the native lung and its impact on survival in patients undergoing single lung transplantation (SLT).

This study retrospectively analyzed 161 SLTs performed between June 2012 and June 2019. The incidence of carcinoma in the native lung and its influence on patient survival was determined. Recipient variables, tumor stage, and survival were analyzed and compared between patients with and without native lung cancer. The analysis was adjusted for transplant indication. Both univariable and multivariable analyses were performed. The present study followed the Declaration of Helsinki Ethical Principles for Medical Research involving human subjects.

There were 161 patients (126 men/35 women; 57 ± 7 years) transplanted for chronic obstructive pulmonary disease (COPD) (n = 72), idiopathic pulmonary fibrosis (IPF) (n = 77), or other indications (n = 12). Eleven patients with COPD (7%) developed lung cancer in the native lung after SLT. Lung cancer did not appear in any of the SLTs for pulmonary fibrosis. Five participants were in stages I/II and underwent lung resection, and 6 participants were in stages III/IV and underwent chemotherapy/radiotherapy. Survival (1, 3, and 5 years) without vs with native lung carcinoma in patients with COPD was 89%, 86%, and 80% vs 86%, 71%, and 51% (P = .04). The occurrence of carcinoma in the native lung predicted survival in patients with COPD (odds ratio [OR]: 2.55; P = .07).

Lung cancer in the native lung is a frequent and devastating complication after SLT in patients with COPD, which might negatively affect long-term survival. This should be considered when choosing the transplant procedure for patients with COPD.