Bronchial carcinoma after lung transplantation: a single-center experience

J Heart Lung Transplant. 2012 Jun;31(6):585-90. doi: 10.1016/j.healun.2012.02.022. Epub 2012 Mar 14.


Background: Lung transplantation (LTx) remains the best option for selected patients with end-stage lung disease. Long-term survival is hampered by the development of chronic allograft dysfunction, which is the main reason for mortality at 3 to 5 years after LTx. Prevalence of and mortality due to solid-organ tumors also increases and we specifically investigated the development of primary bronchial carcinoma (BC) and its outcome after LTx.

Methods: From January 2000 until June 2011, 494 lung and heart-lung transplantations were performed. Among this population, 13 patients developed bronchial carcinoma at 41 ± 27 (mean ± SD) months after LTx. Of these 13 patients, there were 9 men and 4 women. They were transplanted at a mean age of 59 ± 2.8 years; 8 patients were transplanted for emphysema and 5 for pulmonary fibrosis.

Results: Nine of 92 single LTx patients (transplanted for emphysema or lung fibrosis) developed a bronchial carcinoma in their native lung, whereas only 4 of 224 bilateral LTx patients (also for emphysema or fibrosis) developed a bronchial carcinoma (p = 0.0026). At diagnosis, 4 patients had local disease (cT1N0M0 and cT2N0M0), whereas all others had locoregionally advanced or metastatic disease. Five patients were surgically treated; however, 1 had unforeseen N2 disease with additional pleural metastasis at surgery. All other patients (except 2 who died very soon after diagnosis) were treated with chemotherapy with or without radiotherapy. The median survival after diagnosis was only 10 ± 7 months, with a significant survival difference between patients with limited and extensive disease (p = 0.037). The latter had a median survival of only 6 months compared with 21 months for patients with limited stages of bronchial carcinoma.

Conclusions: Bronchial carcinoma, especially of the native lung after single LTx, is a significant problem and the survival after diagnosis is very poor, although patients with limited (operable) disease tend to have better results.

MeSH terms

  • Carcinoma, Bronchogenic / epidemiology*
  • Carcinoma, Bronchogenic / mortality
  • Carcinoma, Bronchogenic / therapy*
  • Combined Modality Therapy
  • Drug Therapy
  • Female
  • Humans
  • Lung Neoplasms / epidemiology*
  • Lung Neoplasms / mortality
  • Lung Neoplasms / therapy*
  • Lung Transplantation*
  • Male
  • Middle Aged
  • Postoperative Period
  • Prevalence
  • Pulmonary Emphysema / surgery
  • Pulmonary Fibrosis / surgery
  • Radiotherapy
  • Retrospective Studies
  • Survival Rate
  • Treatment Outcome