Why Lung Transplants for Lung Cancer Are Rare

Historically, lung cancer was considered an absolute contraindication for lung transplantation. Today, it may be recommended for lung cancer in very rare instances, such as if you are in an early stage of a particular type of lung adenocarcinoma. A lung transplant is not appropriate for most lung cancer patients because it is unlikely to be effective and can pose risks, including recurrence.

Lung transplant surgeries for lung cancer have slowly increased in recent years. But these are unique situations and are the exception, not the rule.

Contraindicating Factors

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

While a lung transplant can beneficial as a treatment for some conditions, lung cancer is usually not one of them. A transplant 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.

Only Addresses Localized Cancer

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 (those 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.

But 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 developing 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 patient receiving a transplant is poor.

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 are causing significant pulmonary distress.

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

  • Diagnoses of lepidic predominant adenocarcinoma, previously known as bronchoalveolar carcinoma (BAC): 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.
  • Early-stage lung cancer in which conventional treatments (e.g., surgical lobectomy) are 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 and it is not likely to be recommended.

In these cases, 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.

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 as part of a combination of treatments. However, it may be the best option for very select people, especially those who are in the early stages of lung cancer but have inoperable tumors.

A Word From Verywell

While a new lung may sound like the solution you've been hoping for, lung transplantation is usually not an option for people living with lung cancer. Unless the cancer is small and isolated to a single lung, a lung transplant could cause more disability or pain. Even with smaller cancers, there is a high likelihood of recurrence.

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 more 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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