With Comparable Outcomes, Should Early Stage Lung Cancer Be A Contraindication to Lung Transplant?

BACKGROUND: Active primary lung malignancy remains a strong contraindication to lung transplantation (LTx). However, outcomes are unclear for patients with early-stage non-small cell lung cancer (NSCLC) who undergo LTx. We hypothesize that patients with early stage NSCLC incidentally discovered in the explanted lungs have comparable survival to LTx recipients without incidental cancer identified.

METHODS: We performed a single-center retrospective analysis of all LTx recipients from May 2007 to September 2021 with incidental cancer identified in the explanted lungs by pathologist report. Survival statistics were estimated using Kaplan-Meier analysis.

RESULTS: Of the 1,586 LTx performed, 23 (1.5%) patients were found to have incidental lung cancer in the explanted lungs. The most common indications for LTx were interstitial lung disease (n=13) and chronic obstructive pulmonary disease (n=7), and the most common histological diagnosis was adenocarcinoma (n=14). In the cohort with Stage I disease (n=9), the 1-year and 5-year unadjusted KM survival rates were 88.9% and 51.9%, respectively. The 1-year and 5-year survival rates for transplants without incidental cancer findings at LTx during this period were 86.7% and 59.4%, respectively, and did not differ significantly between the two strata (p=0.96).

CONCLUSIONS: One- and 5-year survival rates were comparable between LTx recipients with incidentally noted pathological Stage I NSCLC and contemporary recipients without cancer. All cancer-related mortality occurred in recipients with incidentally noted advanced NSCLC. These results suggest that patients with pathological Stage I lung cancer at the time of transplant have outcomes comparable to those without cancer findings at the time of transplant.