1. Incidentally Detected Malignancies in Lung Explants.
- Author
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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., and Walia, Rajat
- Subjects
TREATMENT of lung tumors ,ADENOCARCINOMA ,LUNG cancer ,EVALUATION of human services programs ,ACADEMIC medical centers ,HOMOGRAFTS ,GRAFT rejection ,LUNG transplantation ,RESEARCH methodology ,CANCER chemotherapy ,LUNG tumors ,PATIENTS ,RETROSPECTIVE studies ,ACQUISITION of data ,MYCOPHENOLIC acid ,IMMUNOSUPPRESSION ,COMPARATIVE studies ,MEDICAL records ,CASE studies ,DESCRIPTIVE statistics ,SURVIVAL analysis (Biometry) ,KAPLAN-Meier estimator ,TRANSPLANTATION of organs, tissues, etc. ,SQUAMOUS cell carcinoma ,PNEUMONECTOMY ,DRUG administration ,DRUG dosage - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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