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Spetsotaki K, Koch A, Taube C, Theegarten D, Kamler M, Pizanis N. Incidence of malignancies after lung transplantation and their effect on the outcome. 26 years' experience. Heliyon 2023; 9:e20592. [PMID: 37810874 PMCID: PMC10550624 DOI: 10.1016/j.heliyon.2023.e20592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023] Open
Abstract
Background Malignancy is a significant, life-limiting complication after lung transplantation (LuTx) and the second common long-term cause of death. We aimed to investigate its incidence and effect on the outcome. Methods This is a retrospective observational study. Between 1996 and 2022, n = 627 lung transplantations (LuTx) were performed in our department. We used our institutional database to identify recipients with malignancies after LuTx and examined the malignancies' incidence and mortality. Results N = 59 malignancies occurred in n = 55 (8.8%) LuTx recipients. The post-LTx malignancies incidence was 9.4% (59/627). We report the following rates based on their location: n = 17/55 (28,8% of all recipients diagnosed with malignancies) skin, n = 10/55 (16,95%) gastrointestinal, n = 9/55 (15,3%) respiratory, n = 5/55 (8,48%) lymphatic, n = 13/55 (23,6%) other, n = 5 (8,48%) multiple synchronous.During this study period, a total of n = 328 deaths after LuTx was determined. N = 29 (8,84% of all deaths) were malignancy induced, corresponding to a total malignancy-induced mortality of 4.6% (n = 29/627). The majority of deaths were attributed to GI adenocarcinoma and PTLD. Malignancies' origin, primary COPD diagnosis, type, and specific age group were significantly survival-related (p-values <0.05). The most affected organ was skin and showed the best prognosis. PTLD had the fastest and pancreatic the latest onset. Conclusions This is the first report of its kind in a large cohort of german LuTx recipients. The prevalence ranking of the three commonest malignancy were skin > colorectal > PTLD. Post-LTx malignancy was the second commonest cause of death. Further studies are needed, while post-LuTx malignomas remain a serious impairment of long-term LuTx survival.
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Affiliation(s)
- Konstantina Spetsotaki
- Department of Thoracic Transplantation and Assist Devices, Cardiothoracic Surgery, West German Heart and Vascular Center, University Hospital Essen, Germany
| | - Achim Koch
- Department of Thoracic Transplantation and Assist Devices, Cardiothoracic Surgery, West German Heart and Vascular Center, University Hospital Essen, Germany
| | - Christian Taube
- Department of Pneumology, Ruhrland Clinic, University Hospital Essen, Germany
| | | | - Markus Kamler
- Department of Thoracic Transplantation and Assist Devices, Cardiothoracic Surgery, West German Heart and Vascular Center, University Hospital Essen, Germany
| | - Nikolaus Pizanis
- Department of Thoracic Transplantation and Assist Devices, Cardiothoracic Surgery, West German Heart and Vascular Center, University Hospital Essen, Germany
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Ruiz E, Moreno P, Gonzalez FJ, Fernandez AM, Cantador B, Parraga JL, Salvatierra A, Alvarez A. Influence of De Novo Malignancies on Long-Term Survival after Lung Transplantation. Cancers (Basel) 2023; 15:4011. [PMID: 37568825 PMCID: PMC10417357 DOI: 10.3390/cancers15154011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: Malignancies are an important cause of mortality after solid organ transplantation. The purpose of this study was to analyze the incidence of malignancies in patients receiving lung transplants (LT) and their influence on patients' survival. (2) Methods: Review of consecutive LT from 1994 to 2021. Patients with and without malignancies were compared by univariable and multivariable analyses. Survival was compared with Kaplan-Meier and Cox regression analysis. (3) Results: There were 731 LT malignancies developed in 91 patients (12.4%) with related mortality of 47% (n = 43). Native lung cancer, digestive and hematological malignancies were associated with higher lethality. Malignancies were more frequent in males (81%; p = 0.005), transplanted for emphysema (55%; p = 0.003), with cyclosporine-based immunosuppression (58%; p < 0.001), and receiving single LT (65%; p = 0.011). Survival was worse in patients with malignancies (overall) and with native lung cancer. Risk factors for mortality were cyclosporine-based immunosuppression (OR 1.8; 95%CI: 1.3-2.4; p < 0.001) and de novo lung cancer (OR 2.6; 95%CI: 1.5-4.4; p < 0.001). (4) Conclusions: Malignancies are an important source of morbidity and mortality following lung transplantation that should not be neglected. Patients undergoing single LT for emphysema are especially at higher risk of mortality due to lung cancer in the native lung.
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Affiliation(s)
| | | | | | | | | | | | | | - Antonio Alvarez
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofia, 14004 Cordoba, Spain; (E.R.); (P.M.); (F.J.G.); (A.M.F.); (B.C.); (J.L.P.); (A.S.)
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3
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Tseng SC, Gagne S, Hatabu H, Lin G, Sholl L, Nishino M. Lung Cancer in Lung Transplant Recipients: Clinical, Radiologic, and Pathologic Characteristics and Treatment Outcome. J Comput Assist Tomogr 2023; 47:590-597. [PMID: 36944140 PMCID: PMC10363202 DOI: 10.1097/rct.0000000000001466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE This study aimed to investigate clinical and radiologic characteristics of lung cancer in lung transplant recipients and evaluate the treatment course and prognosis. METHODS The study included 448 patients who underwent lung transplant between 2005 and 2021. All patients had pretransplant chest computed tomography (CT), 429 patients had posttransplant CT, whereas 19 had no posttransplant CT (median number of posttransplant CT, 6; range, 0-24). Medical records of these patients were reviewed to identify patients who developed lung cancer after lung transplant. Computed tomography and positron emission tomography/CT at the time of lung cancer diagnoses were reviewed to obtain imaging features. Demographics, tumor histology, stages, and survival were compared using Fisher exact test and Wilcoxon rank sum test. RESULTS Among 448 lung transplant recipients with a median follow-up of 71.3 months after lung transplant, 15 patients (3.3%) developed posttransplant lung cancer (13 unilateral, 2 bilateral; 10 men, 5 women; median age, 63.1 years; median time from transplantation to cancer diagnosis, 3.1 years). Twelve cancers were in native lung, and 3 were in transplanted lung. The incidence of lung cancer was higher in single lung transplant recipients than in bilateral lung transplant recipients (10.3% vs 0.6%, respectively; P < 0.0001). Imaging manifestations varied according to tumor stages. Among 12 patients treated for lung cancer, 2 patients developed posttreatment acute respiratory distress syndrome. The median survival from cancer diagnosis of cancer was 6.2 months. CONCLUSIONS Posttransplant lung cancer was noted in 3% of lung transplant recipients and was more common in unilateral transplant recipients. The prognosis upon diagnosis was poor with rapid clinical deterioration and serious posttreatment complications.
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Affiliation(s)
- Shu-Chi Tseng
- Department of Imaging, Dana-Farber Cancer Institute 450 Brookline Ave. Boston MA, 02215, USA
- Department of Radiology, Brigham and Women’s Hospital 75 Francis St. Boston MA, 02215, USA
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Staci Gagne
- Department of Imaging, Dana-Farber Cancer Institute 450 Brookline Ave. Boston MA, 02215, USA
- Department of Radiology, Brigham and Women’s Hospital 75 Francis St. Boston MA, 02215, USA
| | - Hiroto Hatabu
- Department of Imaging, Dana-Farber Cancer Institute 450 Brookline Ave. Boston MA, 02215, USA
- Department of Radiology, Brigham and Women’s Hospital 75 Francis St. Boston MA, 02215, USA
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Lynnette Sholl
- Department of Pathology, Brigham and Women’s Hospital 75 Francis St. Boston MA, 02215, USA
| | - Mizuki Nishino
- Department of Imaging, Dana-Farber Cancer Institute 450 Brookline Ave. Boston MA, 02215, USA
- Department of Radiology, Brigham and Women’s Hospital 75 Francis St. Boston MA, 02215, USA
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4
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Post-Transplant Lymphoproliferative Disorder: A Rare Case of CNS Involvement following Renal Transplant. J Clin Med 2022; 11:jcm11237058. [PMID: 36498633 PMCID: PMC9739215 DOI: 10.3390/jcm11237058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/12/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Post-transplant lymphoproliferative disorders (PTLD) are rare immunosuppression complications affecting 5% of transplant patients. Isolated central nervous system (CNS)-PTLD without nodal or extra-nodal organ involvement is rarely reported and is difficult to diagnose due to the non-specific clinical manifestations and imaging features overlapping with other common CNS lesions. CASE PRESENTATION We present a case of a 72-year-old female subjected to a renal transplant 11 years ago with progressively worsening headaches and confusion. Imaging revealed vasogenic edema in the left frontal and bilateral temporal lobes. She was subjected to a craniotomy and excisional biopsy to obtain tissue for diagnostic and therapeutic interventions. Pathology examination showed atypical EBV-positive lymphoplasmacytic infiltrate, consistent with Polymorphic type PTLD. CONCLUSIONS Patients diagnosed with PTLD need to have close monitoring of immunosuppressive medications while in the hospital. Early diagnosis is essential for patient survival with PTLD, as their health can deteriorate fast.
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5
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Park MS. Medical Complications of Lung Transplantation. J Chest Surg 2022; 55:338-356. [PMID: 35924543 PMCID: PMC9358167 DOI: 10.5090/jcs.22.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Moo Suk Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Thaniyavarn T, Grewal HS, Goldberg HJ, Arcasoy SM. Nonallograft Complications of Lung Transplantation. Thorac Surg Clin 2022; 32:243-258. [PMID: 35512942 DOI: 10.1016/j.thorsurg.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Long-term exposure to immunosuppressive therapy may exacerbate pre-existing medical comorbidities or result in the development of new chronic medical conditions after lung transplantation. This article focuses on common nonallograft complications with the highest impact on short- and long-term outcomes after transplantation. These include diabetes mellitus, hypertension, dyslipidemia, kidney disease (acute and chronic), and malignancy. We discuss evidence-based strategies for the prevention, diagnosis, and management of these nonallograft complications in this article.
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Affiliation(s)
- Tany Thaniyavarn
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, PBB Clinic 3, Boston, MA 02115, USA.
| | - Harpreet Singh Grewal
- Lung Transplant Program, Columbia University Irving Medical Center, 622 W 168th Street, PH 14E, Suite 104, New York, NY 10032, USA
| | - Hilary J Goldberg
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, PBB Clinic 3, Boston, MA 02115, USA
| | - Selim M Arcasoy
- Lung Transplant Program, Columbia University Irving Medical Center, 622 W 168th Street, PH 14E, Suite 104, New York, NY 10032, USA
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7
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Kanade R, Kler A, Banga A. Non-pulmonary complications after lung transplantation: part II. Indian J Thorac Cardiovasc Surg 2021; 38:290-299. [DOI: 10.1007/s12055-021-01231-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022] Open
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8
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Muttillo EM, Dégot T, Canuet M, Riou M, Renaud-Picard B, Hirschi S, Guffroy B, Kessler R, Olland A, Falcoz PE, Pessaux P, Felli E. Primary Hepatic Lymphoma After Lung Transplantation: A Report of 2 Cases. Transplant Proc 2021; 53:692-695. [PMID: 33531191 DOI: 10.1016/j.transproceed.2021.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/23/2020] [Accepted: 01/08/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma in the posttransplant setting. Treatment is based on chemotherapy; surgery is still debated and should be performed in very select cases. METHODS We observed 2 patients out of 300 who underwent lung transplantation in the Nouvel Hopital Civil between 2013 and 2019 with primary hepatic lymphoma. Chemotherapy with a rituximab-cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone protocol was performed in all patients. Mycophenolate mofetil was interrupted before treatment, and everolimus was introduced after chemotherapy by associating tacrolimus withdrawal. RESULTS One patient showed complete remission; after 7 years, no recurrence has been noticed. The second is still undergoing chemotherapy with no signs of disease progression. CONCLUSIONS DLBCL risk is higher in solid organ transplant recipients than in the general population. Primary hepatic lymphoma diagnosis is often difficult and based on histologic findings after initial clinical and radiological suspicion of primary or secondary liver neoplasia. Diagnosis is challenging because no clinical, radiological, or biological features exist. Biopsy is always indicated for histologic confirmation. Chemotherapy is the mainstay of therapy, but surgery may be indicated in very select patients.
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Affiliation(s)
- Edoardo Maria Muttillo
- Digestive and Endocrine Surgery, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France; IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France; IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France; Department of Surgical Sciences, Sapienza University of Rome, Rome Italy
| | - Tristan Dégot
- Division of Respiratology and Strasbourg Lung Transplant Program, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France
| | - Matthieu Canuet
- Division of Respiratology and Strasbourg Lung Transplant Program, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France
| | - Marianne Riou
- Division of Respiratology and Strasbourg Lung Transplant Program, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France
| | - Benjamin Renaud-Picard
- Division of Respiratology and Strasbourg Lung Transplant Program, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France
| | - Sandrine Hirschi
- Division of Respiratology and Strasbourg Lung Transplant Program, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France
| | - Blandine Guffroy
- Division of Hematology, ICANS, University of Strasbourg, Strasbourg, France
| | - Romain Kessler
- Division of Respiratology and Strasbourg Lung Transplant Program, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France
| | - Anne Olland
- Division of Thoracic Surgery and Strasbourg Lung Transplant Program, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France
| | - Pierre-Emmanuel Falcoz
- Division of Thoracic Surgery and Strasbourg Lung Transplant Program, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France
| | - Patrick Pessaux
- Digestive and Endocrine Surgery, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France; IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France; IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Emanuele Felli
- Digestive and Endocrine Surgery, Nouvel Hopital Civil, University of Strasbourg, Strasbourg, France; IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France; IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France.
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9
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Iasella CJ, Winters SA, Kois A, Cho J, Hannan SJ, Koshy R, Moore CA, Ensor CR, Lendermon EA, Morrell MR, Pilewski JM, Sanchez PG, Kass DJ, Alder JK, Mehdi Nouraie S, McDyer JF. Idiopathic pulmonary fibrosis lung transplant recipients are at increased risk for EBV-associated posttransplant lymphoproliferative disorder and worse survival. Am J Transplant 2020; 20:1439-1446. [PMID: 31874120 PMCID: PMC8130541 DOI: 10.1111/ajt.15756] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/27/2019] [Accepted: 12/13/2019] [Indexed: 01/25/2023]
Abstract
Epstein-Barr virus (EBV)-associated posttransplant lymphoproliferative disorder (EBV-PTLD) is a serious complication in lung transplant recipients (LTRs) associated with significant mortality. We performed a single-center retrospective study to evaluate the risks for PTLD in LTRs over a 7-year period. Of 611 evaluable LTRs, we identified 28 cases of PTLD, with an incidence of 4.6%. Kaplan-Meier analysis showed a decreased freedom from PTLD in idiopathic pulmonary fibrosis (IPF)-LTRs (P < .02). Using a multivariable Cox proportional hazards model, we found IPF (hazard ratio [HR] 3.51, 95% confidence interval [CI] 1.33-8.21, P = .01) and alemtuzumab induction therapy (HR 2.73, 95% CI 1.10-6.74, P = .03) as risk factors for PTLD, compared to EBV mismatch (HR: 34.43, 95% CI 15.57-76.09, P < .0001). Early PTLD (first year) was associated with alemtuzumab use (P = .04), whereas IPF was a predictor for late PTLD (after first year) (P = .002), after controlling for age and sex. Kaplan-Meier analysis revealed a shorter time to death from PTLD in IPF LTRs compared to other patients (P = .04). The use of alemtuzumab in EBV mismatch was found to particularly increase PTLD risk. Together, our findings identify IPF LTRs as a susceptible population for PTLD. Further studies are required to understand the mechanisms driving PTLD in IPF LTRs and develop strategies to mitigate risk.
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Affiliation(s)
- Carlo J. Iasella
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Spencer A. Winters
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Abigail Kois
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Jaehee Cho
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Stefanie J. Hannan
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ritchie Koshy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Cody A. Moore
- Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christopher R. Ensor
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Elizabeth A. Lendermon
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew R. Morrell
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph M. Pilewski
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Pablo G. Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Daniel J. Kass
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jonathan K. Alder
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - S. Mehdi Nouraie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John F. McDyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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10
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Abstract
Lung transplantation is an established therapeutic option for selected patients with advanced lung diseases. As early outcomes after lung transplantation have improved, chronic medical illnesses have emerged as significant obstacles to long-term survival. Among them is post-transplant malignancy, currently representing the 2nd most common cause of death 5–10 years after transplantation. Chronic immunosuppressive therapy and resulting impairment of anti-tumor immune surveillance is thought to have a central role in cancer development after solid organ transplantation (SOT). Lung transplant recipients receive more immunosuppression than other SOT populations, likely contributing to even higher risk of cancer among this group. The most common cancers in lung transplant recipients are non-melanoma skin cancers, followed by lung cancer and post-transplant lymphoproliferative disorder (PTLD). The purpose of this review is to outline the common malignancies following lung transplant, their risk factors, prognosis and current means for both prevention and treatment.
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Affiliation(s)
- Osnat Shtraichman
- Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Pulmonary Institute, Rabin Medical Center, Affiliated with Sackler School of Medicine Tel Aviv University, Petach Tikva, Israel
| | - Vivek N Ahya
- Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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11
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Sečník P, Jabor A, Lavríková P, Sečník J, Malíková P, Pokorná E, Franeková J. Immunoglobulin abnormalities in 1677 solid organ transplant recipients. Implications for posttransplantation follow-up. Transpl Immunol 2019; 57:101229. [PMID: 31398462 DOI: 10.1016/j.trim.2019.101229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Posttransplant lymphoproliferative disorder (PTLD) is a severe complication of solid organ transplantation (SOT). However, there is no consensus on PTLD screening methods. Gammopathies (GP), which occur in 10-25% of SOT recipients, have been linked to subsequent development of PTLD. Therefore, GP detection methods, such as serum protein electrophoresis (SPE), serum protein immunofixation (SIFE), urine protein immunofixation (UIFE) and the quantitative measurement of serum free light chains (SFLC) are candidate methods for PTLD screening. OBJECTIVE We aimed to assess the frequency of PTLD and GP, association of GP with subsequent PTLD, allograft loss or death and the diagnostic performance of SPE/SIFE in PTLD screening. The main objective was to explore, whether GP detection methods can be used to enhance the efficiency of PTLD screening and to formulate a concise algorithm for posttransplantation (post-Tx) follow-up. METHODS We performed a cohort study on 1677 SOT recipients with SPE/SIFE data who underwent kidney, liver, heart, pancreas, Langerhans islets or multiple organ transplantation at the Institute of Clinical and Experimental Medicine between 1966 and 2015. The median (IQR) of follow-up time was 8.0 (4.0-12.0) years. RESULTS The frequencies of PTLD and GP in SOT recipients were 2.8% and 6.4%, respectively. The frequencies of transient GP, GP of undetermined significance and malignant GP were 33%, 63% and 4% respectively. The median time between SOT and GP detection was 2.0 (interquartile range 1.0-7.0) years. GP was associated with a significantly higher risk of PTLD, allograft loss and death, with hazard ratios (95% confidence intervals) of a 6.06 (2.51-14.64), 2.61 (1.49-4.6) and 1.99 (1.2-3.3), respectively. Additionally, GP was associated with 2.98-fold increased risk of allograft loss in kidney transplant patients. SPE diagnostic sensitivity and specificity for PTLD were 14.8% and 93.9%, respectively. PTLD was diagnosed more often and earlier if SPE/SIFE was included in the post-Tx follow-up. CONCLUSIONS GP after SOT is associated with a high risk of PTLD, allograft loss and poor survival. The combination of SPE, SIFE, SFLC and UIFE is optimal for GP detection. These methods aid in identifying patients who are at risk for PTLD or allograft damage and should be included in regular post-Tx follow-up.
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Affiliation(s)
- Peter Sečník
- 3rd Faculty of Medicine, Charles University, Ruská 2411/87, Prague, Czech Republic.
| | - Antonín Jabor
- 3rd Faculty of Medicine, Charles University, Ruská 2411/87, Prague, Czech Republic; Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague, Czech Republic
| | - Petra Lavríková
- 3rd Faculty of Medicine, Charles University, Ruská 2411/87, Prague, Czech Republic; Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague, Czech Republic
| | - Juraj Sečník
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Neo, Blickagången 16, Sweden
| | - Pavlína Malíková
- Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague, Czech Republic
| | - Eva Pokorná
- Department of Organ Harvesting and Transplantation Databases, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague, Czech Republic
| | - Janka Franeková
- 3rd Faculty of Medicine, Charles University, Ruská 2411/87, Prague, Czech Republic; Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague, Czech Republic
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