Malignancy after Lung Transplantation in Japan

PURPOSE: Malignancy is one of the leading causes of death after organ transplantation. We conducted a national survey of malignancy after lung transplantation among all lung transplant centers in Japan. METHODS: All recipients who underwent lung transplantation since October 1998 until December 2017 in Japan were retrospectively reviewed. RESULTS: Malignant diseases developed in 41 (6.9%) of 596 lung transplant recipients in 388 brain-dead donor lung transplantation and 208 living donor lobar lung transplantation. Except recurrence of the original malignant diseases (n=4/596, 0.7%) and possible progression after transplantation in cancer-baring recipients (n=5/596, 0.8%), de novo malignancy occurred in 33 patients (5.5%). The most common de novo malignancy was lymphoproliferative disorder (n=16/34, 46%). Compared with the ISHLT registry, we observed far fewer skin cancer (n=1). In terms of the underlying disease for lung transplantation, interstitial pneumonitis (n=13/33, 39%) and lung complication after hematopoietic stem cell transplantation (n=10/33, 30%) were common, suggesting that long-term immunosuppression before and after transplantation has a negative impact on occurrence of de novo malignancy. The average time of occurrence after transplantation was 39 (±38) months. Death due to malignancy occurred in 11/33 (33%). The overall 5-year survival of patients with malignancies after lung transplantation was 49%. CONCLUSION: In Japan, the most common malignancy after lung transplantation was posttransplant lymphoproliferative disorder. Long-term immunosuppression before and after transplantation can have a negative impact on occurrence of de novo malignancy after lung transplantation.