The association between pretransplant malignancy and post-transplant survival and cancer recurrence in bilateral lung transplantation: An analysis of 23,291 recipients
Background: Given the increasing need for lung transplants among older patients with a history of cancer, this study analyzed database registry to assess outcomes for bilateral lung transplant (BLT) recipients with pre-transplant malignancy (TM). Methods: This study evaluated the United Network for...
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Elsevier
2025-02-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133424001101 |
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| author | Wongi Woo, MD Hye Sung Kim, MD Ankit Bharat, MBBS Young Kwang Chae, MD, PhD, MBA |
| author_facet | Wongi Woo, MD Hye Sung Kim, MD Ankit Bharat, MBBS Young Kwang Chae, MD, PhD, MBA |
| author_sort | Wongi Woo, MD |
| collection | DOAJ |
| description | Background: Given the increasing need for lung transplants among older patients with a history of cancer, this study analyzed database registry to assess outcomes for bilateral lung transplant (BLT) recipients with pre-transplant malignancy (TM). Methods: This study evaluated the United Network for Organ Sharing registry for adult BLT performed between 2005 and 2023. Patients with a history of previous or multiorgan transplants, and those with donors who had cancer history, were excluded. Propensity score matching was used to compare patients with or without pre-TM. Overall and post-TM-free survival were analyzed. Results: Among the 23,291 recipients of BLT, 8.0% (1,870) had pre-TM. Compared to those without pre-TM, patients with pre-TM had worse overall (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.12-1.29, p < 0.001) and post-TM-free survival (HR 1.32, 95% CI 1.24-1.41, p < 0.001). However, after adjusting for age, sex, and race through propensity score matching, the survival difference between the groups became nonsignificant (HR 1.05, 95% CI 0.97-1.13, p = 0.229). While the pre-TM group still had worse post-TM-free survival, this difference diminished after excluding cutaneous post-TM (HR 1.06, 95% CI 0.99-1.15, p = 0.116). Additionally, the recurrence rate of pre-TM after transplant was not higher than de novo cancers in patients without pre-TM. Conclusions: Patients with pre-TM had similar survival rates after BLT as those without pre-TM. Importantly, there was no increased risk of the primary pre-TM type recurring post-transplant compared to patients without pre-TM. If patients with pre-TM are free from recurrence or metastasis for a significant time, there could be some who can benefit from BLT. Further data regarding timeline between pre-TM and BLT would be necessary to draw conclusion in this issue. |
| format | Article |
| id | doaj-art-dd3a42e982834dd48207b629a342b32b |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
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| series | JHLT Open |
| spelling | doaj-art-dd3a42e982834dd48207b629a342b32b2025-02-09T05:01:52ZengElsevierJHLT Open2950-13342025-02-017100161The association between pretransplant malignancy and post-transplant survival and cancer recurrence in bilateral lung transplantation: An analysis of 23,291 recipientsWongi Woo, MD0Hye Sung Kim, MD1Ankit Bharat, MBBS2Young Kwang Chae, MD, PhD, MBA3Department of Internal Medicine, Dignity Health St. Joseph’s Medical Center Stockton, Stockton, CaliforniaDepartment of Internal Medicine, Temple University Health System, Philadelphia, PennsylvaniaNorthwestern University Feinberg School of Medicine, Chicago, IllinoisNorthwestern University Feinberg School of Medicine, Chicago, Illinois; Corresponding author: Young Kwang Chae, MD, PhD, MBA, Northwestern University Feinberg School of Medicine, Chicago, IL.Background: Given the increasing need for lung transplants among older patients with a history of cancer, this study analyzed database registry to assess outcomes for bilateral lung transplant (BLT) recipients with pre-transplant malignancy (TM). Methods: This study evaluated the United Network for Organ Sharing registry for adult BLT performed between 2005 and 2023. Patients with a history of previous or multiorgan transplants, and those with donors who had cancer history, were excluded. Propensity score matching was used to compare patients with or without pre-TM. Overall and post-TM-free survival were analyzed. Results: Among the 23,291 recipients of BLT, 8.0% (1,870) had pre-TM. Compared to those without pre-TM, patients with pre-TM had worse overall (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.12-1.29, p < 0.001) and post-TM-free survival (HR 1.32, 95% CI 1.24-1.41, p < 0.001). However, after adjusting for age, sex, and race through propensity score matching, the survival difference between the groups became nonsignificant (HR 1.05, 95% CI 0.97-1.13, p = 0.229). While the pre-TM group still had worse post-TM-free survival, this difference diminished after excluding cutaneous post-TM (HR 1.06, 95% CI 0.99-1.15, p = 0.116). Additionally, the recurrence rate of pre-TM after transplant was not higher than de novo cancers in patients without pre-TM. Conclusions: Patients with pre-TM had similar survival rates after BLT as those without pre-TM. Importantly, there was no increased risk of the primary pre-TM type recurring post-transplant compared to patients without pre-TM. If patients with pre-TM are free from recurrence or metastasis for a significant time, there could be some who can benefit from BLT. Further data regarding timeline between pre-TM and BLT would be necessary to draw conclusion in this issue.http://www.sciencedirect.com/science/article/pii/S2950133424001101lung transplanttransplant malignancypost-transplant malignancyUNOStransplant oncology |
| spellingShingle | Wongi Woo, MD Hye Sung Kim, MD Ankit Bharat, MBBS Young Kwang Chae, MD, PhD, MBA The association between pretransplant malignancy and post-transplant survival and cancer recurrence in bilateral lung transplantation: An analysis of 23,291 recipients JHLT Open lung transplant transplant malignancy post-transplant malignancy UNOS transplant oncology |
| title | The association between pretransplant malignancy and post-transplant survival and cancer recurrence in bilateral lung transplantation: An analysis of 23,291 recipients |
| title_full | The association between pretransplant malignancy and post-transplant survival and cancer recurrence in bilateral lung transplantation: An analysis of 23,291 recipients |
| title_fullStr | The association between pretransplant malignancy and post-transplant survival and cancer recurrence in bilateral lung transplantation: An analysis of 23,291 recipients |
| title_full_unstemmed | The association between pretransplant malignancy and post-transplant survival and cancer recurrence in bilateral lung transplantation: An analysis of 23,291 recipients |
| title_short | The association between pretransplant malignancy and post-transplant survival and cancer recurrence in bilateral lung transplantation: An analysis of 23,291 recipients |
| title_sort | association between pretransplant malignancy and post transplant survival and cancer recurrence in bilateral lung transplantation an analysis of 23 291 recipients |
| topic | lung transplant transplant malignancy post-transplant malignancy UNOS transplant oncology |
| url | http://www.sciencedirect.com/science/article/pii/S2950133424001101 |
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