Liver transplantation-associated lung cancer in smokers: Results of an early CT detection program

•Annual screening program for liver transplant patients with a history of smoking.•Low-dose CT screening allows early lung cancer detection in liver transplant patients.•CT images showed mostly solid pulmonary nodules with quite a rapid volume-doubling time.•Almost 90% of cancers were detected at stage I/II, and 85% were treated curatively. Lung cancer (LC) is more prevalent and has poorer prognosis in liver transplant (LT) patients with a history of smoking than in the general smoking population. In 2012, we launched a chest computed tomography (CT) scan program for early detection of LC in LT patients with a history of smoking. Here, we describe the CT features of LC in this population. Patients with a history of smoking treated by LT for alcoholic liver disease between 2005 and 2019 and diagnosed with LC between January 2012 and September 2019 were included. Clinical data, radiological and histological characteristics were collected. Since 2012, 34 LC were diagnosed; 28 cancers were detected in 18 patients through the early detection program, and 6 cancers were detected during an intercurrent event. Among LC, 53% were adenocarcinomas and 32% were squamous cell carcinomas; 73% were located in the upper lobes. On CT scans, pulmonary nodules appeared as follows: 67% solid, 15% mixed, 12% pure ground glass, and 6% excavated. Cancers were diagnosed at stage I (68%), stage II (21%), and stages III (6%) and IV (6%). In total, 85% of LC were treated curatively. LC developing in LT patients are mostly invasive adenocarcinomas located in upper lobes. On CT scan images, nodules appear as solid rather than mixed or ground glass opacification. Post-liver transplant lung cancers (PLTLC) may be quite aggressive tumors.