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Impact of Donor Cancer-Free Interval on Post-Transplant Malignancy After Lung Transplantation
Abstract   Peer reviewed

Impact of Donor Cancer-Free Interval on Post-Transplant Malignancy After Lung Transplantation

M. Daniel, J. Song, S. McKay, H. Zappacosta, P. Cho, J. White, A. Abramov, D. Telesca and A. Ardehali
The Journal of heart and lung transplantation, v 45(5), pp 506-506
Apr 2026

Abstract

Purpose: The use of donor lungs from individuals with prior malignancy remains controversial due to concern for transmission and post-transplant cancer risk. This study evaluated whether the donor cancer-free interval modifies the risk of post-transplant malignancy among lung transplant recipients. Methods: The UNOS database was queried for adult recipients of isolated lung transplants performed between April 1994 and June 2025 using donors with a history of malignancy. The primary outcome was development of post-transplant malignancy. Cox proportional hazards regression identified predictors of post-transplant cancer, focusing on the donor’s cancer-free interval (time from completion of cancer treatment to organ procurement). Comparisons used chi-square or Fisher’s exact tests, as appropriate. Results: Among 812 lung transplant recipients of donors with prior malignancy, 69 (8.5%) developed post-transplant cancer. Affected recipients were older (61 ± 9 vs. 57 ± 11 years, p=0.004) and more often male (72.5% vs. 58.6%, p=0.03). Donor age (46 ± 12 vs. 44 ± 11 years, p=0.29), cancer type (p=0.81), and cancer-free interval (12.1 ± 10.4 vs. 11.5 ± 9.6 years, p=0.56) were similar between groups. On multivariable analysis, recipient age (HR 1.04 per year, 95% CI 1.01-1.07, p=0.01) predicted post-transplant malignancy, while donor cancer-free interval showed no significant association. Conclusion: Post-transplant malignancy among recipients of donor lungs with prior cancer is uncommon and not influenced by the donor’s cancer-free interval. These findings suggest that with careful donor selection and cancer history assessment, prior donor malignancy should not automatically preclude lung donation, potentially expanding the donor pool safely.

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