近期有恶性肿瘤病史患者的双肺移植

Introduction: Recent history of malignancy usually within five years is a contraindication for double lung transplantation (DLT). However, the relationship between a recent history of malignancy and lung transplantation outcomes is unclear. Method: Patients with respiratory failure and a history of cancer in the last five years treated with DLT were identified between 09/2021 and 1/2026. All patients had enrolled in the DLT registry aimed for lung-limited malignancies (DREAM) study cohort C (NCT05671887). Exclusion criteria included the presence of extrapulmonary metastatic disease and medical ineligibility for DLT. Standard staging work-up confirmed the absence of distant metastasis. All patients were followed up with computed tomography every 12 weeks. Results: 19 consecutive patients who underwent DLT were included (age 27-74, 12 male, 7 female, and 13 former smokers). 11 lung (stage IA2-IIIB), three prostate (stage I-IIc), two testicular, one breast, one bladder, and one skin cancer cases were included. Among lung cancer patients, six patients had adenocarcinoma, four squamous cell carcinoma, and one poorly differentiated non-small cell carcinoma. Prior to DLT, patients received radioimmunotherapy (n=1), chemoradiotherapy (n=2), chemoradiotherapy plus immunotherapy (IO) (n=2), radiotherapy alone (n=3), and chemotherapy alone (n=3). The duration of IO was a median of 2 (2-18) months. The IO-free interval was 11, 27, and 44 months before DLT. All patients had high oxygen requirements before DLT. The indications for DLT were COPD (n=5), IO-related ILD (n=3), IPF (n=2), and COVID-related ILD (n=1). Transplant rejection did not occur, and all patients were discharged on room air. The median overall survival after transplantation was 21 (6-59) months. 3 patients passed away at 9, 6, and 6 months post-DLT (2 died of respiratory failure, 1 died of cardiac arrest). 2 patients had new primary cancers which were surgically resected (1 had pancreatic cancer, 1 had prostate cancer). Conclusion: 19 patients, with a history of malignancy within 5 years, successfully underwent DLT for non-malignant indications of respiratory failure without significant complications. Ongoing DREAM study cohort C will continue to investigate the role of DLT in patients with a recent history of malignancy.