Mesothelioma after lung transplantation

Surgical Complications of Lung Transplantation

Lung transplantation is a life-saving intervention and the most effective therapy for select patients with irreversible lung disease. Despite the effectiveness of lung transplantation, it is a major operation with several opportunities for complications. For example, recipient and donor factors, technical issues, early postoperative events, and immunology can all contribute to potential complications. This article highlights some of the key surgery-related complications that can undermine a successful lung transplantation. The authors offer their expert opinion and experience to help practitioners avoid such complications and recognize and treat them early should they occur.

Medical Course and Complications After Lung Transplantation

Lung transplant prolongs life and improves quality of life in patients with end-stage lung disease. However, survival of lung transplant recipients is shorter compared to patients with other solid organ transplants, due to many unique features of the lung allograft. Patients can develop a multitude of noninfectious (e.g., primary graft dysfunction, pulmonary embolism, rejection, acute and chronic, renal insufficiency, malignancies) and infectious (i.e., bacterial, fungal, and viral) complications and require complex multidisciplinary care. This chapter discusses medical course and complications that patients might experience after lung transplantation.

Mesothelioma in an HIV/AIDS patient without history of asbestos exposure: possible role for immunosuppression in mesothelioma: a case report

We describe a 41-year-old African-American male who initially presented in respiratory distress. He had a positive history of asthma, cigarette smoking, and only recent possible asbestos exposure six months prior to onset of symptoms. Mesothelioma was suspected after chest radiography and PET-CT, and confirmed by immunohistochemical tissue analysis. We postulate that immunosuppression enhances susceptibility to mesothelioma, since weakened immune systems are present in both HIV/AIDS patients like this 41-year-old man, and elderly patients who compose the population that classically presents with mesothelioma. Furthermore, immunosuppression may be a prerequisite to the development of mesothelioma.

Susceptibility and resistance in the genesis of asbestos-related mesothelioma

Asbestos is the principal agent in the etiology of malignant mesothelioma. However, a small proportion of people exposed to asbestos develop mesothelioma. This suggests the role of host factors in the genesis of the tumor. A genetic susceptibility is suggested by the occurrence of more mesothelioma cases among blood-related members of a single family. Such an occurrence reached about 4% in a large mesothelioma series. In some studies, mesothelioma patients showed higher prevalences of additional malignancies when compared with controls. This indicates a particular vulnerability to cancer in people with mesothelioma. Not rarely, very old persons heavily exposed to asbestos remain free from asbestos-related cancer, a fact indicating an absolute resistance to the oncogenic effects of asbestos. A relative resistance may be recognized in people severely exposed to asbestos who develop mesothelioma only after 60 years or more since the onset of the exposure. The long survivals, rarely observed among mesothelioma patients, have been attributed to a high efficiency of immune mechanisms. Mesotheliomas have been reported among people with severe immune impairment, such as acquired immunodeficiency syndrome patients or organ transplant recipients. The natural history of mesothelioma shows that a resistance to the oncogenic effects of asbestos does exist. Probably, such a resistance is due to the efficient immune mechanisms. To strengthen the defence mechanisms may represent a way for preventing mesothelioma among people exposed to asbestos.