Utilization and outcomes of lung transplant from donors with cancer: a UNOS study.

Background: Lung transplants from deceased donors who have a cancer diagnosis are rare due to concerns of tumor transmission to the recipients. In this study, we reviewed the use and outcomes of lung transplantation using donors with cancer at time of procurement. Methods: Data from 935 donors with a diagnosis of cancer at procurement were identified from the United Network for Organ Sharing from 2006 to 2023. Recipients of allografts from donors with cancer were propensity matched to a control group. Univariable comparisons and Kaplan-Meier analyses were performed to compare donor and recipient characteristics and outcomes. Results: Utilization of lungs in donors with a cancer diagnosis at procurement was 13% (7.6% for extracranial and 25% for intracranial tumors). Over a 10-year follow-up period, recipients of lungs from donors with cancer had comparable incidence rates of de novo (25% vs. 19%) or donor-related cancer (0.9% vs. 0.07%) when compared to recipients of organs from donors without a cancer diagnosis in the matched cohort (P>0.05). Conclusions: Based on the analysis of limited data from United Network for Organ Sharing (UNOS) database, utilizing lungs from donors with cancer diagnoses did not demonstrate differences in long-term survival or risks of cancer on recipients. Further studies involving clinical characteristics of donor cancers are critical to validate the conclusion of this study.