The association between pretransplant malignancy and post-transplant survival and cancer recurrence in bilateral lung transplantation: An analysis of 23,291 recipients

Abstract

Background

Given the increasing need for lung transplants among older patients with a history of cancer, this study analyzed database registry to assess outcomes for bilateral lung transplant (BLT) recipients with pre-transplant malignancy (TM).

Methods

This study evaluated the United Network for Organ Sharing registry for adult BLT performed between 2005 and 2023. Patients with a history of previous or multiorgan transplants, and those with donors who had cancer history, were excluded. Propensity score matching was used to compare patients with or without pre-TM. Overall and post-TM-free survival were analyzed.

Results

Among the 23,291 recipients of BLT, 8.0% (1,870) had pre-TM. Compared to those without pre-TM, patients with pre-TM had worse overall (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.12-1.29, p < 0.001) and post-TM-free survival (HR 1.32, 95% CI 1.24-1.41, p < 0.001). However, after adjusting for age, sex, and race through propensity score matching, the survival difference between the groups became nonsignificant (HR 1.05, 95% CI 0.97-1.13, p = 0.229). While the pre-TM group still had worse post-TM-free survival, this difference diminished after excluding cutaneous post-TM (HR 1.06, 95% CI 0.99-1.15, p = 0.116). Additionally, the recurrence rate of pre-TM after transplant was not higher than de novo cancers in patients without pre-TM.

Conclusions

Patients with pre-TM had similar survival rates after BLT as those without pre-TM. Importantly, there was no increased risk of the primary pre-TM type recurring post-transplant compared to patients without pre-TM. If patients with pre-TM are free from recurrence or metastasis for a significant time, there could be some who can benefit from BLT. Further data regarding timeline between pre-TM and BLT would be necessary to draw conclusion in this issue.