Lung transplantation in patients with previous or unknown oncological disease: evaluation of short- and long-term outcomes

Simple Summary Lung transplantation (LTX) is the treatment of choice for patients with end-stage lung disease but its role is still controversial in those with a history of malignancies. The aim of this study was to evaluate short- and long-term outcomes in patients submitted to LTX with a history of previous neoplasia or oncological disease detected in the native lung. Our study showed that this population had worse overall survival compared to a control group, emphasizing the importance of an accurate selection and a strict post-operative follow-up in this group of patients.Abstract The accurate selection of the recipient is a crucial aspect in the field of lung transplantation (LTX), especially if patients were previously affected by oncological disease. The aim of this bicentric retrospective study was to evaluate short- and long-term outcomes in patients with previous oncological disease or unknown neoplasia found on native lungs submitted to LTX, compared to a control group. A total of 433 patients were included in the analysis, 31 with malignancies (Group 1) and 402 without neoplastic disease (Group 2). The two groups were compared in terms of short- and long-term outcomes. Patients in Group 1 were older (median age 58 years vs. 50 years, p = 0.039) and mostly affected by idiopathic pulmonary fibrosis (55% vs. 40% p = 0.002). Even though in Group 1 a lower rate of late post-operative complications was found (23% vs. 45%, p = 0.018), the median overall survival (OS) was lower compared to the control group (10 months vs. 29 months, p = 0.015). LTX represents a viable therapeutic option for patients with end-stage lung disease and a history of neoplastic disease. However, every case should be carefully debated in a multidisciplinary setting, considering oncological (histology, stage, and proper disease free-interval) and clinical factors (patient's age and comorbidities). A scrupulous post-transplant follow-up is especially mandatory in those cases.