Abstract
Purpose Development of cancer is recognized as one of the main causes of death after lung transplantation. We aimed to propose an equation for cancer risk after lung transplantation. Methods Retrospective study of all cases of cancer diagnosed in a Spanish Transplant Unit between 1999 and 2017. A control group consisted of lung transplant patients that did not develop cancer during the follow-up, matched by date of lung transplantation. The excess risk of cancer was calculated as odds ratio, being the best equation selected that which uses the allsets method with subsequent inclusion of the parameters in a logistic regression. Survival curves were analyzed with Kaplan-Meier. The statistical analysis was done with Stata 14.2 Results Out of 630 lung transplantations, 48 cancers were diagnosed: 11 skin (22.92%), 8 lymphoma (16.67%), 8 lung (16.67%), 7 gastrointestinal (14.58%) and 7 others (14.58%). There were no significant differences regarding: indication for lung transplantation (p 0.86), age (p 0.50), gender (p 0.09), follow-up time (p 0.84), acute rejection (p 0.58), chronic rejection (p 0.69) or immunosupprive regimen (p 0.22). In the univariate analysis, cancer development was associated with cytomegalovirus infection/disease (p 0.005) and bilateral lung transplant (p 0.01). In the multivariate analysis adjusted for gender according to allsets method CMV infection/disease had an OR of 3.83 (95% IC 1.31-11.13), bilateral comparing to single lung transplant had an OR of 0.38 (95% IC 0.15-0.97) and men comparing to women had an OR of 1.67 (95% IC 0.78-4.80). A final risk equation for cancer after lung transplantation was developed, as follows: p(cancer)= -0,38 + (1,34 x CMV) + (-0,96 x lung transplant type)+(0,52 x gender). Conclusion CMV infection/disease and the type of lung transplant procedure were strong predictors for the development of cancer. There is a need to identify specific tests that permit early diagnosis of the most frequent cancers in these high-risk patients.
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