Incidental lung cancer of explanted lungs: a single-center retrospective experience

Background Recent history of malignancy without 5-year disease-free interval is an absolute contraindication for lung transplantation (LuTx), but rare lung cancer cases are detected at explant. Methods We performed a retrospective review of incidental lung cancer of explanted lungs(2013-2023), and summarized clinical characteristics and prognosis. Results Six patients had lung cancer at LuTx(4 males, 2 females), with average age 56.8±4.4 years, fivehad bilateral LuTx, one unilateral. Indications for LuTx were COPD (n=3) and pulmonary fibrosis (n=3). The postoperative TNM stages were IA1 (n=2), II (n=3), and IIIA (n=1), histology was adenocarcinoma (n=3), squamous carcinoma (n=2), and carcinoid (n=1); The median interval from the last CT to LuTx was 89 days (24-404). Pre-transplant CTs reviewed retrospectively found suspicious nodules in 4 patients. Median follow-up time was 42 months (5,113). Median PFS and OS were 11 and 14 months, respectively; 1-, 3-, and 5-year OS were 83%, 50%, and 50%. No patients received adjuvant chemotherapy after LuTx. Three developed recurrence with extrapulmonary metastases within one year while three continue to be free of recurrence. Conclusions Detecting lung cancer in explanted lungs remains challenging due to severe fibrosis and emphysema. Incidental malignancies remain unavoidable despite thorough pre-transplant evaluation. Current practice emphasizes balancing immunosuppression and cancer control, often using mTOR inhibitors. Based on our small sample cohort, long term recurrence free survival seems possible in early stage explanted lung cancer, suggesting that selected patients with a suspicious nodule may benefit from LuTx. Multicenter studies are needed to optimize management strategies and inform guidelines in the future. Publication History Article published online: 04 March 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany