Bronchogenic carcinoma in solid organ transplant recipients

Malignancies are increased in some types of solid organ transplant patients receiving immunosuppressive therapy and are a significant contributor to patient morbidity and mortality. There may be a 100-fold increase in the incidence of de novo neoplasia in this population. The risk of lymphoproliferative malignancies is well appreciated. In contrast, the risk of solid tumors with their consequent morbidity and mortality is less well known, probably because of their common occurrence in the general population. Lung cancer is the most common cause of cancer death in the United States; therefore, lung cancer in patients undergoing organ transplantation would be expected to occur frequently on the basis of chance alone. However, the lung cancer risk is approximately 20 to 25 times that of the general population, with an incidence of 0.28% to 4.1% in patients after heart and lung transplant. Risk factors thought to contribute include cigarette smoking, advanced age at transplantation, and chronic immunosuppressive therapy. The role of transplantation (and consequent therapy) in the development of lung cancer in this high-risk population remains unclear. As in the nontransplant population, adequate screening techniques are lacking, making early diagnosis and treatment a challenge. Despite close follow-up and routine imaging with chest radiography and CT, lung cancers continue to be discovered incidentally and at advanced stages. Treatment is similar to that of patients who are nontransplanted with similar stage, histology, and performance status.