Malignancy After Lung Transplantation: A Literature Review

Background: Over the past two decades there have been significant improvements in the quality of life and long-term survival of lung transplant patients. Nevertheless, it has been noted that a number of malignancies have developed in lung-transplant recipients pursuant to lung transplantations. It is therefore important for medical practitioners, other health care workers, and the public to be aware and well informed about the types of malignancies that develop after lung transplantation. Aim: To review the literature on malignancies that develop pursuant to lung transplantations. Literature Review: A number of malignancies have been reported following lung transplantation and these include: Post-transplantation lymphoproliferative disorders; Skin cancers – non-melanotic skin cancers (squamous cell carcinomas; basal cell carcinomas); Kaposi’s sarcoma; Bronchogenic carcinomas; lymphomas; Carcinomas of colon; Adenocarcinomas of stomach; Adenocarcinomas of prostate; Renal carcinomas; Laryngeal cancers; Seminomas; Basaliomas; Carcinoma-in-situ of the cervix; Bladder cancer; Breast cancer; Hepato-biliary carcinoma; Anal cancer; Other miscellaneous malignancies. A multitude of predisposition factors have been postulated to be responsible for the development of the various malignancies that develop after lung transplantation. It has been stipulated that the aetiology of post-transplantation malignancies involve a combination of: * Impaired renal function * Impaired immune activity against viruses * DNA damage and disruption of DNA repair mechanisms * Promotion of tumour progression by cytokine up-regulation and transforming growth factor 1, interleukin IL-10 and vascular endothelial growth factor. Conclusion and Recommendations: A number of malignancies develop after lung-transplantation in view of this careful and regular follow-up assessment of all lung-transplant recipients is required for the early detection and management of cancer. Pre-disposing factors for the development of malignancy should be avoided / minimised in the lung-transplant recipient.