Influence of De Novo Malignancies on Long-Term Survival after Lung Transplantation

SIMPLE SUMMARY: Lung transplant recipients are at high risk of malignancies. Despite the continuous improvements in lung transplant outcomes over time, limited knowledge exists about the real impact of de novo malignancies developing in lung transplant recipients on their long-term survival. For this reason, we aimed to assess the prevalence of de novo malignancies in a large cohort of lung transplant recipients, their influence on long-term survival, and whether malignancies were an independent risk factor for mortality. We found that 12% of the overall series developed some type of malignancy, with malignancy-related mortality for almost half of the patients developing malignancies. This finding reflects the magnitude of the problem. Furthermore, we observed that de novo lung cancers were the most lethal, affecting the native lungs of recipients receiving single lung transplants. This observation makes it necessary to reconsider performing single lung transplants, especially in patients with chronic obstructive pulmonary disease. 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.