06. PTC: Cancer Risks for Lung Recipients
Lung Transplant Recipients at Higher Risk for Lung Cancer Than General Population
A recent analysis of the Transplant Cancer Match (TCM) Study underscores how the risk for lung cancer is increased in recipients of lung transplants compared with individuals in the general public (Am J Transplant. 2018 Dec 18. Epub ahead of print).
“Lung transplant recipients have an increased risk of lung cancer that is poorly understood. Prior studies are largely descriptive and single-center, and have not examined risk factors or outcomes in this population,” said Matthew A. Triplette, MD, MPH, Assistant Professor, Department of Medicine, University of Washington, Seattle, and colleagues.
People who have received a lung transplant have an increased risk of developing cancer at a later date. This would usually be one of the following:
- skin cancer
- lung cancer
- liver cancer
- kidney cancer
- non-Hodgkin lymphoma – which is a cancer of the lymphatic system
Because of this increased risk, regular check-ups for these sorts of cancers may be recommended.
Post-transplantation lymphoproliferative disorder
After having a lung transplant, your risk of developing a lymphoma (usually a non-Hodgkin lymphoma) is increased. This is known as post-transplantation lymphoproliferative disorder (PTLD).
PTLD occurs when a viral infection (usually the Epstein-Barr virus) develops as a result of the immunosuppressants that are used to stop your body rejecting the new organ.
PTLD affects around one in 20 people who have a lung transplant. Most cases occur within the first year of the transplant. It can usually be treated by reducing or withdrawing immunosuppressant therapy.
Lung transplantation has come a long way in recent years and will advance even more as the development of ex vivo lung perfusion becomes common practice, making more lungs available for transplant.
Lung transplantation is the only life–saving therapy for patients with certain types of end–stage lung disease; however the procedure has limited availability because not all donor lungs are safe for transplantation. This shortage of donor lungs results in the death of 20 percent of lung transplant candidates awaiting transplant.
Ex vivo lung perfusion (EVLP) is an innovative therapy applied to donor lungs outside of the body before transplantation that improves organ quality and makes lungs that were previously unsuitable safe for transplant.
The process involves a three-to-four-hour period during which the donated lungs are placed inside a sterile plastic dome attached to a ventilator, pump, and filters. The lungs are maintained at normal body temperature and treated with a bloodless solution that contains nutrients, proteins, and oxygen. This can reverse lung injury and remove excess lung water. During the process, lung function is evaluated continuously on several key indicators. Once determined to be suitable, the lungs are transplanted into a waiting patient.