Balancing cancer recurrence risk and respiratory mortality: Immediate listing for lung transplantation following HCC therapy

Malignancy usually requires a cancer-free interval before lung transplantation, although individualized exceptions are allowed based on tumor biology and recurrence risk. We report a case of urgent bilateral lung transplantation performed 30 days after curative-intent therapy for hepatocellular carcinoma (HCC) in a 66-year-old man with rapidly progressive idiopathic pulmonary fibrosis. Over 52 months of MRI surveillance, there was no evidence of HCC recurrence. The patient ultimately died 4 years after transplantation from advanced chronic lung allograft dysfunction. This case illustrates that, in exceptionally selected patients with localized HCC and documented response to locoregional therapy, expedited lung transplant listing may be clinically and ethically justified when near-term respiratory mortality outweighs the anticipated risk of cancer recurrence. Such decisions should remain individualized and multidisciplinary rather than broadly generalizable.