Comparison of Lung Cancer Screening Programs in Liver Transplant Recipients and the General Population

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.