Are Lung Transplant Patients More Prone to Cancer?

A lung transplant involves replacing a diseased lung with a healthy lung from a donor. Surgeons can swap out one or both lungs during this operation. Transplantation is an option for people with failing lungs due to a variety of health conditions. If a lung transplant is successful, it can offer many patients a longer, better quality of life.

However, there are also serious risks to consider, including a higher chance of developing certain types of cancer after the transplantation. This risk is attributed to conventional risk factors, such as a history of smoking in both recipients and donors, and to immunosuppression after transplantation.

This article discusses who benefits from a lung transplant, the risks involved, and the likelihood of developing cancer after surgery.

Who Is the Ideal Candidate for a Lung Transplant?

A lung transplant may be a suitable option for some people with the following conditions: 

• Cystic fibrosis: An inherited disease that causes issues in the glands that make mucus and sweat
• Chronic obstructive pulmonary disease (COPD): A group of chronic, inflammatory lung diseases that includes emphysema and chronic bronchitis
• Pulmonary hypertension: Characterized by high blood pressure in the lungs
• Pulmonary fibrosis: Scarring of the lungs
• Heart disease or heart defect: Heart problems that affect the lungs, such as pulmonary heart disease
• Other conditions: Sarcoidosis and histiocytosis, which can cause severe lung damage

Transplantation is only an option for patients after other treatments have failed. A lung transplant surgery is usually not recommended for people with lung cancer except in very select cases.

Healthcare providers use strict criteria for determining who qualifies for a lung transplant. Ideal candidates include those who:

• Are physiologically 60 years old or younger (for a double lung transplant), meaning a person’s physical condition must be equivalent to that of someone age 60 or younger
• Are physiologically 65 years old or younger (for a single lung transplant), meaning a person’s physical condition must be equivalent to that of someone age 65 or younger
• Have a poor prognosis with a short life expectancy
• Have a good support system
• Don’t have other life-threatening diseases
• Have shown they will comply with provider's recommendations and medication instructions
• Understand the risks and benefits of organ transplantation

What Are the Risks of a Lung Transplant?

Some risks of a lung transplant include:

• Rejection of the organ
• Infection
• Bleeding
• A blockage in the blood vessels to the new lung or lungs
• Airway blockages
• Fluid in the lungs
• Blood clots
• Rarely, death

Risk of Cancer After Lung Transplant

The risk of developing cancer after transplantation is also a concern for people who undergo the surgery. Solid organ transplant recipients, including those who have lung transplants, have a twofold increased risk for developing cancer than the general population. What’s more, these cancers are usually more difficult to treat and have a worse prognosis (expected outcome). 

According to a report by the International Society for Heart and Lung Transplantation, cancer was the second most common cause of death among lung transplant recipients five to 10 years after surgery.

Studies show the most common cancer after a lung transplant is squamous cell cancer of the skin, which is likely due to the intensity of immunosuppression needed to prevent implant rejection. Experts recommend that lung transplant recipients have annual skin cancer screenings.

Additionally, lung transplant recipients have an increased risk of lung cancer compared to the general population. People who have one lung transplanted, as opposed to two, are more likely to develop lung cancer, and it usually occurs in their native lung (the remaining lung they were born with). The risk of lung cancer in the native lung may be linked to history of smoking and underlying smoking-associated conditions, such as emphysema or pulmonary fibrosis.

Lymphomas are also common cancers among transplant recipients.

What Are the Benefits of a Lung Transplant?

A lung transplant can offer many advantages for patients with end-stage lung failure who are appropriate candidates.

Prolonged life is the biggest benefit. The surgery also increases your chances of having a better quality of life, with better lung function than you had before.

After a lung transplant, everyday activities are easier to perform. Traveling is more feasible and many people report an improved sex life.

Lung Transplant Prognosis 

The outlook for lung cancer recipients is improving each year, but survival rates are still relatively low.

Recent statistics have shown 85% of transplant recipients will be alive after one year, and 59% will be alive five years later. Some studies have suggested the median survival is approaching seven years. 

Of course, a person's individual prognosis depends on many factors, including age and overall health.

Summary

While a lung transplant can improve your survival outlook and quality of life, it comes with a set of risks. Cancer is a possible complication. The most common cancers that may develop after a lung transplant include squamous cell carcinoma, lymphoma, and lung cancer.

You will have to discuss the benefits and risks of transplantation with a healthcare provider before deciding to undergo the surgery.

A Word From Verywell

A successful lung transplant can be a game-changer for many people with lung failure. Though the risk of cancer does exist, you may be willing to accept this possibility when you consider the benefits transplantation provides. Be sure to talk to your healthcare provider about all of your concerns and stay on top of all your medical appointments after a transplant to identify any signs of cancer early on.