Bronchogenic Carcinoma after Lung Transplantation: Characteristics and Outcomes

Background: Lung cancer may occur in the lung transplant population because many patients are former smokers. Not much is known about risk factors and outcomes in these patients. Methods: We performed a search of the lung transplant database at our institution to identify patients who had been diagnosed with lung cancer. Records and reports were reviewed for demographics, risk factors for malignancy, lung transplant characteristics, radiographic characteristics, treatment, and outcomes. Results: We identified 12 lung transplant patients with bronchogenic carcinoma at our institution [age 47.2 ± 13.2 years (mean ± SD); 7 (58%) men and 5 (42%) women]. Eleven patients were transplanted for chronic obstructive pulmonary disease (COPD). Time from transplantation to diagnosis of cancer was 119 (21–416) [mean (range)] weeks. Eleven cancers occurred in the native lung; most common cancer cell types were adenocarcinoma (N = 5). Incidence among patients with COPD, who received single lung transplantation was 5.15%. Time from diagnosis of bronchogenic carcinoma to death was 10.8 (1–60) [mean (range)] weeks with a 75% (9/12) 1-year mortality. Conclusions: Among our patients, almost all cancers occurred in native lung in ex-smokers who received a lung transplant for COPD. The cancer was often an incidental finding on a routine chest radiograph; however, the disease was usually at an advanced stage at diagnosis, limiting therapeutic options.