06. PTC: Cancer Risks for Lung Recipients

All organ transplant recipients are at heightened risk of developing cancer after transplant. This is because although life-sustaining, long-term use of immunosuppressant drugs lowers the body’s ability to fend off certain cancers. When you are taking immunosuppressant drugs, your immune response is lowered, and this is what helps to prevent your body from rejecting your new lung. It also means that your body is less able to recognize and destroy cancer cells or infections that can cause cancer.

Additionally, because immunosuppressant drugs reduce your body’s natural monitoring and disease response, you are at increased risk of developing certain viral infections that are linked to increased cancer risk. Examples of these viruses the Herpes virus which is associated with Kaposi sarcomas or viral-induced lymphomas. Epstein-Barr virus is common and is associated with lymphoma (PLTD), Hepatitis which is linked to liver cancer, and the Human Papilloma Virus (HPV) that is associated with skin cancers. There is also a small chance that the lung you receive is cancerous, or if you only have one lung transplanted, your other lung could have had cancer already.

Note: For full versions of any of the INTRO video clips below, go to the full library of ONLINE resources at https://www.triowebptc.org/link/resource-library.html

For all people, cancer risk increases as a natural part of the aging process. There are also certain lifestyle choices that can raise your risk of cancer, such as not getting regular exercise, smoking, or having a poor diet. Exposure to asbestos can cause lung diseases like asbestosis and silicosis that are risk factors for lung cancers. Some research from Olland and colleagues in the Journal of Thoracic Disease has shown that 5 years after transplant, 18% of patients develop cancer, and 10 years after transplant 29% of patients develop cancer. People who are older at the time of receiving the lung transplant (over 60 years old) are at a slightly higher risk of developing cancer than those that are younger. People who are over the age of 50 at time of transplant are 6% likely to develop some type of cancer, and people who are over the age of 60 when they receive their lung transplant are 14% likely to develop some type of cancer.

Below you can read about some of the most common cancers for lung transplant recipients like skin, breast and cervical cancer, kidney cancer, liver cancer and even lung cancer. Explore the look pages to learn more about each of these types of cancer and how to manage your risk.

• Skin Cancer: Some research has found that skin cancer was diagnosed for 16% or about 2,900 of the 18,093 people who received a lung transplant who participated in their study that were on a 3-medicine immunosuppressant prescription. The other causes of skin cancer, as mentioned above were HPV, and lots of sun exposure, especially for people with fair skin.
• Breast Cancer: Women over the age of 40 when they receive their lung transplant are at higher risk of developing breast cancer than those who are younger than 40 years old.
• Prostate Cancer: Men over the age of 40 when they receive their lung transplant are at higher risk of developing prostate cancer than those who are younger than 40 years old.
• Lung Cancer: The main cause of lung cancer for lung transplant recipients is smoking. Smoking can cause COPD/emphysema. Smoking can also cause cancer in the bladder, urinary tract, esophagus, pancreas, kidney, stomach, and cervix.  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.
  click here for full article

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 a donor's 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.

View a YouTube video on that ex vivo lung perfusion subject here:  Ex Vivo Lung Perfusion
And for more click to see this TED talk: TED Med 2013

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