Objectives: The objectives of this study are to analyse whether liver transplant recipients (LTR) have a higher incidence of lung cancer (LC) compared to a population of high risk smokers enrolled in a LC screening program and to evaluate if LC screening results allow an early diagnosis in LTRs. Methods: We conducted a retrospective study comparing LC screening outcomes using low-dose computed tomography (LDCT) in 124 LTRs and 485 matched non-immunosuppressed controls. Matching criteria included age, sex, smoking history, active smoking status, and presence of emphysema. Tumour characteristics, staging, treatment, and survival were analysed. Results: LC was diagnosed in 9.7% of LTRs and 4.5% of controls (p = 0.11). LTRs more frequently presented with squamous cell carcinoma, while adenocarcinoma predominated in controls. Early-stage diagnosis (stage IA) was more common in LTRs (83.4% vs. 50%, p = 0.056). Survival after diagnosis was comparable between groups in the first three years, although LTRs showed reduced long-term survival. Multivariate analysis identified cumulative tobacco exposure >35 pack-years (HR = 3.0; p = 0.003), and centrilobular emphysema (HR: 2.8; p=0.004) as independent risk factors for LC, liver transplantation showed an association close to significance (HR: 1.9; p = 0.08). Conclusions: LTRs have a higher incidence of LC than matched non-immunosuppressed individuals. LDCT screening enables early detection and favourable outcomes. These findings support routine LC screening in high-risk LTRs, particularly those with significant smoking histories, and centrilobular emphysema.
Lam et al. (Wed,) studied this question.