Evaluating cancer risk profiles in lung transplant recipients.

Background: De novo post-transplant malignancy (PTM) is a significant complication after transplantation. Limited research exists on the incidence rates in recent lung transplant recipients (LTRs). This study aims to determine the risk spectrum of malignancies in LTRs and analyze their temporal evolution. Methods: Data on 32,480 LTRs were extracted from the United States (U.S.) Organ Procurement Transplant Network/United Network for Organ Sharing (UNOS) database. We described the annual incidence rates and calculated the standardized incidence ratio (SIR). Results: Among the 32,480 LTRs, the cancer incidence rate was 23.11%. The incidence of malignancies varied over time, initially increasing and then stabilizing in the first 10 years post-transplant. The overall incidence of cancers excluding non-melanoma skin cancer (NMSC) remained stable, with some tumors linked to viral infections being more common early on. Older age at transplantation and male gender were associated with higher cancer incidence risk. Besides cutaneous squamous cell carcinoma (cSCC) (n=3,706) and basal cell carcinoma (BCC) (n=1,054), the most common malignancies were lung cancer [n=580; incidence rate 455.55 per 100,000 person-years (PY); SIR =4.088] and non-Hodgkin lymphoma (NHL) (n=578; incidence rate 453.98 per 100,000 PY; SIR =13.266). Conclusions: LTRs have a higher cancer risk compared to the general population. Targeted monitoring based on PTM occurrence patterns is necessary to prevent and detect tumors early. These findings assist in identifying high cancer incidence periods and guide predictions of tumor development.