655: Incidence of De Novo Malignancies in Lung Transplant Recipients in Italy: A Single-Institution Experience, 1991-2008 (original) (raw)
Related papers
Analysis of Lung Transplant Recipients Surviving Beyond 5 Years
Transplantation Proceedings, 2005
Introduction. We started lung transplantation (LT) in October 1993 and review the status of recipients who have survived beyond 5 years. Methods. A retrospective review of patients undergoing LT from October 1993 to October 1998 included pulmonary function data, incidence of bronchiolitis obliterans syndrome (BOS), functional status, and survival. Results. Of 73 transplantations 41 (56%) patients have survived beyond 5 years (study group), including 23 men and 18 women of age 33.2 Ϯ 15.6 years. Indications for LT were as follows: cystic fibrosis (n ϭ 16), emphysema (n ϭ 13), pulmonary fibrosis (n ϭ 8), and other (n ϭ 4). Actuarial survival at 5, 7, and 9 years was 56%, 53%, and 43%, respectively. Freedom from BOS was 63%, 56%, and 50% at 5, 7, and 9 years, respectively. The median percent predicted FEV1 was 67%, 56%, and 56%, respectively. Also, 79% of recipients had no limitations in their daily activities; 65% were active and working. Only 5% of patients showed some degree of limitation at 5 years posttransplantation. When survivors beyond 5 years were compared with nonsurvivors beyond 5 years, differences were observed: nonsurvivors more frequently required bypass (P ϭ .01), experienced longer postoperative intubation times (P ϭ .01), and exhibited lower PaO2 at 12 months posttransplantation (P Ͻ .01). Conclusion. Our data show good survival rates among patients surviving beyond 5 years after LT, with a moderate incidence of BOS at 9 years posttransplantation. Despite the incidence of BOS, these patients have good pulmonary function and activity status.
Improved results after lung transplantation--analysis of factors
Swiss medical weekly, 2001
Better recipient selection, sophisticated postoperative surveillance and new immunosuppressive and anti-infective regimens can improve the results of lung transplantation. We compared the results of lung transplants performed between 1992 and 1996 (early period; 47) and between 1997 and 2000 (recent period; 46) in a cohort study to assess which factors influenced survival. Estimates of relative hazards were adjusted for possible confounding effects with the use of Cox regression analysis. Overall 2-year survival was 70%. Survival by this time was significantly better in the recent period (82% vs. 60%; p = 0.0093). Acute rejection episodes and death due to BOS were less frequent in the recent period. There were no technical failures, and the cumulative incidence of BOS was low (34% at 5 years). The beneficial effect of the transplantation date 1997 or later at a hazard ratio of 0.33 (95% CI, 0.13-0.84) was materially changed only by the adjustment for ganciclovir prophylaxis (0.50; 9...
Malignancies following lung transplantation: the Portuguese experience
Journal of Cancer Prevention & Current Research, 2019
Malignancy is an important complication after lung transplantation (LT), which is related to common risk factors in these patients, oncogenic viruses and immunosuppression therapy (IST). We retrospectively analyzed all cases of malignancy in the 182 patients that underwent LT between June 2001 and December 2017 in Portugal. We noticed an incidence of 7.6%, similar to that described in the literature, with a mean age of 53 years and a mean time after LT of 25 months. As in other series, the most common types of cancer were skin cancer (2.7%), post transplant lymphoproliferative disorders (2.2%) and lung cancer (1.6%). Unexpectedly we found an important incidence of gastric cancer (1,1%) not previously described in the literature that we relate to the elevated incidence of this cancer in our country. All patients underwent treatment and IST adjustments, according to a multidisciplinary team approach. In this series, 4 patients died due to cancer (33.3%) with a median survival of 26 months. We conclude that cancer is an important complication after LT and further investigation and awareness is needed to optimize diagnosis and management of this condition.
Outcome of lung transplantation in elderly recipients
European Journal of Cardio-Thoracic Surgery, 2011
Objective: Lung transplantation is a standard treatment option for patients with end-stage lung disease. Lung transplantation in the elderly is controversial due to concerns over anticipated increased surgical risks, inferior long-term outcomes and proper stewardship in allocating limited donor organs. With demographic trends showing an increasing proportion of patients over 60 years old, we evaluated our outcomes with lung transplantation in this older cohort. Methods: Between January 1990 and July 2009, 142 patients underwent lung transplantation at our institution. A total of 15 patients receiving heart/lung transplantation and one patient declining research participation were excluded. As many as 126 patients were analyzed in two groups: <60 and !60 years old. Results: There were 65 females (52%) and 61 males (48%). A total of 53 patients (42%) underwent bilateral sequential lung transplantation and 73 patients single-lung transplantation (58%). Median age at transplantation was 55.3 years (range, 21.6-73.1 years) with 94 patients <60 years (75%) and 32 patients !60 years (25%). Median follow-up was 4.3 years (range, 0-17.8 years). Overall survival at 30 days was 93.7% with no difference between age groups ( p = 0.95). There was no difference between the groups for in-hospital, postoperative complications ( p = 0.86), or unplanned readmission rates within 90 days of the hospitalization ( p = 0.26). Postoperative pulmonary function (forced expiratory volume in 1 s (FEV1) % predicted) at transplant, 4 weeks, 3 months, and 6 months after transplantation was not different between groups ( p = 0.93). No difference in long-term survival was observed ( p = 0.59), with 5-year survival of 52.2% for patients <60 years and 47.3% for patients !60 years. Overall, 20 patients developed bronchiolitis obliterans syndrome and 13 posttransplant lymphoproliferative disease, which was not statistically different between age groups ( p = 0.87, p = 0.37, respectively). Conclusion: Increased age of 60 years and greater, in highly selected patients, does not appear to have a significant impact on the shortor long-term outcome in patients undergoing lung transplantation. Judicious selection of older patients, who are otherwise excellent candidates for lung transplantation, remains a reasonable option. #
The Journal of Heart and Lung Transplantation, 2010
Despite 20 years of lung transplantation (LTx), factors influencing long-term survival remain largely unknown. The United Network for Organ Sharing (UNOS) data set provides an opportunity to examine long-term LTx survivors. We conducted a case-control study embedded within the prospectively collected UNOS LTx cohort to identify 836 adults from 1987 to 1997 who survived &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=10 years after first LTx. LTx patients within the same era and surviving 1 to 5 years served as controls. Multivariable logistic regression with incorporation of spline terms evaluated the odds of being a 10-year survivor. Two separate models were constructed. Model A incorporated pre-operative, operative, and donor-specific factors. Model B incorporated the factors used in Model A with post-operative covariates. Additional outcomes evaluated included hospitalizations for infection, rejection, and bronchiolitis obliterans. Of 4,818 LTx patients from 1987 to 1997, 836 (17.3%) survived &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=10 years with a mean follow-up of 148.8 +/- 21.6 months. Mean follow-up for 1,657 controls was 34.0 +/- 13.9 months. The distribution of 10-year survivors by disease was cystic fibrosis, 170 (20%); chronic obstructive pulmonary disease, 254 (30%); and idiopathic pulmonary fibrosis, 92 (11%). On multivariable logistic regression, significant factors influencing 10-year survival included age &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or=35 years (odds ratio [OR] 1.07, 95% confidence interval [CI], 1.03-1.11; p = 0.01), bilateral LTx (OR. 1.71; 95% CI, 1.25-2.34; p = 0.001), and hospitalizations for infections (OR, 1.40; 95% CI, 1.27-1.54; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and for rejection (OR, 0.55; 95% CI, 0.48-0.65; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Examination of a cohort of long-term LTx survivors in the UNOS data set indicates that bilateral LTx and fewer hospitalizations for rejection may portend improved long-term survival after LTx.
Lung cancer in lung transplant—management and outcomes
Current Challenges in Thoracic Surgery, 2021
Risk factors for lung cancer and end-stage lung disease significantly overlap, therefore index of suspicion for lung cancer should be high in lung transplant candidates. Thoracic surgeons can be faced with clinical scenarios where lung cancer can be discovered in the setting of lung transplant in three distinct categories: (I) transplant candidates who are known to have active or treated lung cancer, (II) transplant recipients who have unexpected incidental cancer discovered in their lung explant, and (III) transplant recipients who develop de novo lung cancer in the lung allograft or native lung after single-lung transplant. While previously considered "lung-limited" disease, bronchioloalveolar carcinoma (BAC) is no longer accepted as an indication for lung transplant due to poor outcomes with high recurrence rates and reclassification as invasive cancer. Any active lung cancer is considered a contraindication to transplant; however, if there is no evidence of disease after 5 years of definitive therapy, lung transplant can be offered. Indeterminate pulmonary nodules are common in lung transplant candidates and should be evaluated in a multidisciplinary fashion. Incidental lung cancer found in explanted lungs portends poor survival. De novo lung cancer after transplant is more common in the native lung after single-lung transplant. Cancer that develops in the allograft can be treated with definitive local therapies and systemic therapies, but long term survival has not yet been demonstrated.