Why Lung Transplants for Lung Cancer Are Rare

Why It May or May Not Be an Option

Lung transplant surgery is not normally a treatment option for lung cancer patients. Historically, lung transplants were considered an absolute contraindication for the disease, meaning the procedure should be avoided altogether. However, in very rare instances, a lung transplant for lung cancer may be recommended, such as if you're suffering from early-stage lung cancer with a particular type of lung adenocarcinoma.

In fact, while it is still only used infrequently, lung transplants surgeries for lung cancer have slowly increased in recent years. These unique situations, however, are the exception, not the rule.

Why Transplants Are Not Usually Recommended

A lung transplant is surgery that removes a diseased lung and replaces it with a healthy lung from a living or deceased donor. Doctors can transplant one or both lungs.

A lung transplant (single or double) is not a good treatment option for lung cancer patients because it is unlikely to get rid of all the cancer cells while leaving you in a weakened state, which may prevent you from fighting the remaining malignancy. There is also a very high risk for recurrence that may minimize the benefit of a transplant.

Local vs Systemic Treatment

A transplant is considered a type of local treatment, which means it is addressing cancer in one area only. Unfortunately, in 70% of cases, lung cancer has spread beyond the initial tumor area at the time of diagnosis.

If cancer has spread beyond the lungs to lymph nodes or even metastasized (spread) to distant regions of the body, local treatments are not enough. To treat lung cancer that has spread, doctors need to use systemic treatments (treatments that work on cancer cells throughout the body) such as chemotherapytargeted therapies, and immunotherapy.

As part of a typical course of lung cancer treatment, doctors often combine systemic with local treatments such as lung cancer surgery or radiation therapy. This combination can better ensure all cancer is eliminated. However, a transplant is major surgery that puts excessive stress on your body and requires post-operative immunosuppressant medications. After a transplant, your body is not likely to be able to tolerate chemo or other systemic treatments. This means that if a lung transplant doesn't remove all your cancer cells, you would be unable to immediately undergo further treatments that would prevent cancer from spreading.

Risk of Recurrence

The risk of lung cancer in a transplanted lung is higher than the risk of lung cancer in the general population. Those odds are significantly increased if the transplanted organ is given to a person who has had lung cancer. The risk of lung cancer recurrence in the transplanted lung can be as high as 75% for lung cancer patients. That means the overall prognosis for a lung cancer patients receiving a transplant is poor.

With the limited availability of donor lungs, doctors must prioritize who receives new organs. Patients are scored based on several criteria including current health and post-transplant survival predictions. Considering the poor outcomes associated with lung cancer patients after a transplant, it's hard for them to be given priority on a donor waiting list.

Rare Instances of Transplants for Lung Cancer

The number of lung transplants performed for lung cancer in the United States is only about 0.13%. These rare surgeries may be recommended to those who have limited tumors that haven't spread but which are causing significant pulmonary distress.

Two possible scenarios that may be considered for a lung transplant to treat lung cancer include:

  • Diagnoses of lepidic predominant adenocarcinoma, previously known as bronchoalveolar carcinoma (BAC), may qualify for a transplant. Unlike other forms of lung cancer that often spread to the lining of the lungs and other regions of the body, this type of cancer usually remains within one lung.
  • In early-stage lung cancer, conventional treatments such as a surgical lobectomy are sometimes impossible due to poor lung function related to end-stage COPD or other lung diseases. These scenarios may be considered for lung transplants. However, if you've already had surgery that removed cancerous tissues, the prognosis is very poor for a lung transplant. Your doctor is not likely to recommend the transplant in such cases.

In these settings, a lung transplant may be considered when non-surgical alternatives can't provide adequate control of the cancer. In order to be successful, doctors need to carefully select people who may benefit from a lung transplant and make sure that the cancer is carefully staged. Tests such as a PET scan and an endobronchial ultrasound should show no evidence of cancer spread beyond the lungs. 

Limitations

If a lung transplant is considered appropriate to treat your lung cancer, doctors will still need to consider some complications that can arise.

  • Extra care must be taken to ensure that the donor lung isn't contaminated with cancer cells during implantation of the new lungs (especially cells that may remain in the upper airways).
  • Ethical concerns regarding how to allocate the limited number of donor lungs must be addressed. These are related to the uncertainty about long-term survival in those with cancer compared to others waiting for a lung. The final decision is difficult for surgeons and patients to weigh.
  • Because transplants are so rare for lung cancer patients, there is a lack of strong research or clinical studies on the efficacy of lung transplants for lung cancer patients. Thus, there are few well-researched best practices to help doctors manage complications or particular needs of patients.

Prognosis

A lung transplant may be used both as an effort to cure lung cancer or as a palliative treatment (with the intent to prolong life but not cure the disease).

For people who received a lung transplant, the five-year survival rate is around 54%. This includes people who have received transplants for various reasons such as advanced COPD. That survival rate is comparable to the 56% survival rate for lung cancer when it's localized (limited to the lungs) at the time of diagnosis.

Can you get a lung transplant? In some unique cases, yes. But because of the limited number of people who have undergone transplant surgery to treat lung cancer, it's difficult to say that a transplant is as effective as traditional lung cancer surgery or a combination of treatments. However, it may be the best option for select people, especially those who are in the early stages of lung cancer but have inoperable tumors.

can you get a lung transplant

Personal Story

When living with cancer, there is nothing better than hearing about people who have "been there." Many in the lung cancer community were inspired by former college football player Jerrold Dash, who shared his journey in receiving a bilateral lung transplant for cancer that was stage 4 BAC. Dash survived for 13 years after his transplant, living a full life with his wife and daughters. In his blog, he shared his thoughts about his lung cancer fight.

A Word From Verywell

A lung transplant is usually not an option for people living with lung cancer. In fact, unless the cancer is small and isolated to a single lung, a lung transplant could cause more disability or pain. Even with smaller cancers, the likelihood of cancer recurring lessens the chance that a lung transplant would be effective.

However, for some people, such as those with lepidic predominant adenocarcinoma, a lung transplant may be a viable option. The risks of this surgery need to be weighed carefully against any expected benefit. If you and your doctor think that the circumstances are just right for this rare step, you'll need to be prepared for the long-term recovery and complications.

More likely, though, new forms of treatment such as targeted therapies and immunotherapy can offer hope and should be explored. These are certainly less complicated options and have been, increasingly, improving survival rates for lung cancer patients.

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