(1) 背景：恶性肿瘤是固体器官移植后的重要死因。本研究的目的是分析接受肺移植的患者中恶性肿瘤的发生率及其对患者生存的影响。 (2) 方法：回顾了1994年至2021年的连续肺移植情况。使用单变量和多变量分析比较了有恶性肿瘤和无恶性肿瘤的患者。采用Kaplan-Meier和Cox回归分析比较生存情况。 (3) 结果：91名患者中发生了731例肺移植后恶性肿瘤（占12.4%），相关的死亡率为47%（n = 43）。原发性肺癌、消化系统和血液系统恶性肿瘤与较高的致死率相关。男性中恶性肿瘤发生率更高（81%; p = 0.005），患有肺气肿的受者（55%; p = 0.003），使用环孢素类免疫抑制剂的受者（58%; p < 0.001），以及进行单侧肺移植的受者（65%; p = 0.011）中恶性肿瘤发生率更高。有恶性肿瘤的患者（总体）和有原发性肺癌的患者的生存情况较差。导致死亡的危险因素是使用环孢素类免疫抑制剂（OR 1.8；95%CI: 1.3-2.4；p < 0.001）和新发性肺癌（OR 2.6；95%CI: 1.5-4.4；p < 0.001）。 (4) 结论：恶性肿瘤是肺移植后发生的重要的引起发病率和死亡率的因素，不容忽视。接受单侧肺移植治疗肺气肿的患者特别容易由于原发性肺癌引发死亡的风险较高。

(1) Background: Malignancies are an important cause of mortality after solid organ transplantation. The purpose of this study was to analyze the incidence of malignancies in patients receiving lung transplants (LT) and their influence on patients' survival. (2) Methods: Review of consecutive LT from 1994 to 2021. Patients with and without malignancies were compared by univariable and multivariable analyses. Survival was compared with Kaplan-Meier and Cox regression analysis. (3) Results: There were 731 LT malignancies developed in 91 patients (12.4%) with related mortality of 47% (n = 43). Native lung cancer, digestive and hematological malignancies were associated with higher lethality. Malignancies were more frequent in males (81%; p = 0.005), transplanted for emphysema (55%; p = 0.003), with cyclosporine-based immunosuppression (58%; p < 0.001), and receiving single LT (65%; p = 0.011). Survival was worse in patients with malignancies (overall) and with native lung cancer. Risk factors for mortality were cyclosporine-based immunosuppression (OR 1.8; 95%CI: 1.3-2.4; p < 0.001) and de novo lung cancer (OR 2.6; 95%CI: 1.5-4.4; p < 0.001). (4) Conclusions: Malignancies are an important source of morbidity and mortality following lung transplantation that should not be neglected. Patients undergoing single LT for emphysema are especially at higher risk of mortality due to lung cancer in the native lung.