Lung transplantation for emphysema: only emphysema or something else?

Area of Science:

• Pulmonary Medicine
• Transplant Pathology
• Histopathology

Background:

• Previous studies have examined lung explant histology for pretransplant neoplasms and its link to interstitial lung disease (ILD).
• Histopathological analysis of explanted lungs following lung transplantation (LT) is crucial for understanding underlying conditions.

Purpose of the Study:

• To review the histopathology of explanted lungs from patients who underwent lung transplantation (LT).
• To compare the frequency of additional histological diagnoses between LT recipients with emphysema and patients with COPD and lung cancer.

Main Methods:

• Retrospective, single-center study of LT recipients for emphysema (2011-2021).
• Control group: Surgically treated lung cancer patients with prior COPD diagnosis (2011-2019).
• Systematic review of histological findings to compare additional diagnoses.

Main Results:

• Study included 160 LT recipients (emphysema) and 205 cancer patients (COPD).
• LT recipients had significantly more additional histological diagnoses (58.1% vs. 12.7%, P<0.001), including ILD and pneumoconiosis.
• Cancer group was older with more comorbidities and higher tobacco consumption.

Conclusions:

• Significant additional histological findings were more common in emphysema patients undergoing LT.
• These findings were not attributable to tobacco use.
• Transplant recipients showed more frequent unexpected histological findings than COPD patients with lung cancer, despite the latter's higher tobacco use and better respiratory function.