Malignancy Risk in Lung Transplant Recipients with Short Telomere Length

Abstract

<h3>Purpose</h3> Short telomere lengths (TL) are seen in 10% of lung transplant recipients (LTRs) with interstitial lung disease (ILD). Short TL and immunosuppression predispose to carcinogenesis. We assess whether LTRs with short TLs have a compounded malignancy risk. <h3>Methods</h3> This is a single-center retrospective analysis from 1/2012 - 1/2017. LTR records were queried for TL, malignancy, and cancer risk factors. TL was assayed in ILD candidates with cytopenias, abnormal liver function and coagulation, splenomegaly, premature graying, or ILD family history. Lymphocyte TL was assessed via flow-FISH (Repeat Dx) and was age-adjusted; values <10^th percentile were defined as short. LTRs were administered standard induction and maintenance immunosuppression, and antimicrobial prophylaxis. . LTRs underwent age-appropriate cancer screening. Statistical analysis was performed using SSS (StatCorp); Fisher's Exact, Pearson's Chi square, and Wilcoxon's rank sum tests were used for binary, categorical and continuous data, respectively. P-values ≤ 0.05 were significant. <h3>Results</h3> 19/233 (8.2%) LTRs had short TLs. There were no inter-cohort differences in baseline traits (<b>Table 1</b>). Five (26.3%) LTRs with short TLs developed malignancy, compared to 45 (21%) patients with presumed normal TLs. There was a significant difference in hematologic malignancy rate in those with short TLs (40% vs. 0%, p=0.009). There was no difference in time to cancer diagnosis or survival (<b>Table 3</b>). <h3>Conclusion</h3> LTRs with short TLs may be predisposed to hematologic malignancy. Study limitations include size, the single-center, retrospective design, and that only a sub-set of patients had TL measured.