Lung transplant in patients with suspicious lung lesions: A single-center retrospective data analysis

Patients with suspicious pulmonary lesions are traditionally rejected or delisted for lung transplantation (LTx). Data on the overall prevalence of suspicious lung lesions in candidates for LTx, their characteristics, and the proportion of malignancy among these lesions are lacking.

We performed a retrospective analysis of all patients with suspicious lung nodules who underwent LTx between January 2012 and October 2022. We compared characteristics of lesions, assessed definitive histology reports, analyzed postoperative outcomes, and calculated overall survival at 1-, 3-, and 5-years.

Out of 1070 transplanted patients, 79 (7.4%) had suspicious lung lesions prior to LTx. In this group, COPD was the most frequent indication for LTx (83.5% of patients). Pathology reports confirmed lung cancer in explanted native lungs in only 12 of the 79 patients (15.1%). The most common lung cancer entity was adenocarcinoma in 8 patients (66.7%). Ten of the 12 (83.3%) patients were in stage I, II and 2 (16.6%) patients were in stage-IIIA disease based on final histological work-up after LTx. Overall survival did not differ between 'malignant nodules' subgroup, 'non-malignant nodules' subgroup and their respective matched controls at 1 year (87.5% vs 89.7% vs 88.2%), 3 years (87.5% vs 78.6% vs 77.5%) or 5 years (87.5% vs 70.1% vs 68.6%) (cox proportional-hazards model, p=0.541).

Patients with unverified suspicious lung lesions should not be excluded from LTx, as only a small proportion of these nodules are malignant. Long-term survival is unaffected even in cases the explanted lung harbors an early-stage lung cancer.