Incidentally Detected Malignancies in Lung Explants. (December 2022)

• Record Type: Journal Article
• Authors: Razia, Deepika; Arjuna, Ashwini; Trahan, Amy; Hahn, Mary F.; Abdelrazek, Hesham; Omar, Ashraf; Tokman, Sofya; Hashimi, Abdul Samad; Huang, Jasmine; Smith, Michael A.; Bremner, Ross M.; Walia, Rajat
• Is Part Of: Progress in transplantation. Volume 32:Number 4(2022)
• Page Start: 332
• Page End: 339
• Publication Date: 2022-12
• Subjects: incidental malignancy -- lung cancer -- lung explant -- lung transplantation -- adenocarcinoma; Transplantation of organs, tissues, etc -- Periodicals; Transplantation; Organ Procurement; Tissue Donors; Transplantation of organs, tissues, etc; Electronic journals; Periodicals; Periodicals; 362.1783
• DOI: 10.1177/15269248221122876
• Languages: English
• ISSNs: 1526-9248

Abstract

Introduction: Incidentally detected malignancies in lung explants portend risk of early cancer recurrence and metastases with posttransplant immunosuppression. We present a series of lung transplant recipients with previously unverified malignancies in native lung explants.Design: We reviewed the histopathology, radiographic imaging, and management of lung explant malignancies at our institution over 10 years (2011-2020). Endpoints were survival and allograft rejection.Results: An explant malignancy was found in 1.3% (11/855) of lung transplant recipients (6 [55%] men; median age 68 years; 6 [55%] ex-smokers [median pack-years, 25]). Nine (82%) were adenocarcinoma, 1 (9%) was squamous cell carcinoma (SCC), and 1 (9%) was follicular lymphoma. Three patients (27%) had multifocal involvement (≥3 lobes), 4 (36%) had nodal involvement, and the median (range) tumor size was 2.7 (0.4-19) cm. The median interval between last imaging and transplant was 58 (29-144) days. Mycophenolate mofetil was discontinued or reduced in all; everolimus was used in 2 patients, and cisplatin-pemetrexed chemotherapy was used in 2 patients. The prevalence of acute cellular rejection and chronic rejection was 27% and 9%, respectively. Lung recipients with cancer had significantly lower survival than those without (36.4% vs 67.3%, p = 0.002); median survival was 27 (17, 65) months in 4 recipients who were alive and cancer-free at the end of the study period.Conclusions: Unidentified malignancies, commonly adenocarcinoma, can be detected in explanted native lungs. Pneumonectomy may be curative in SCC, lymphoproliferative disorders, and stage I adenocarcinoma. Modulating immunosuppression to prevent allograft rejection and tumor proliferation is warranted.