Double lung transplantation in patients with recent history of malignancy.

e22542 Background: Recent history of malignancy usually within five years is a contraindication for double lung transplantation (DLT). However, the relationship between a recent history of malignancy and lung transplantation outcomes is unclear. Methods: Patients with respiratory failure and a history of cancer in the last five years treated with DLT were identified between 09/2021 and 11/2024. All patients had enrolled in the DLT registry aimed for lung-limited malignancies (DREAM) study cohort C (NCT05671887). Standard staging work-up confirmed the absence of any distant metastasis. All patients were followed up with computed tomography every 12 weeks. Results: 14 consecutive patients who underwent DLT were included (age 58-75, 10 male, 4 female, and 13 former smokers). 10 patients had primary lung (stage IB-IIIB), two had prostate (stage I-IIc), one had bladder, and one had skin cancer. Among lung cancer patients, five patients had adenocarcinoma, four squamous cell carcinoma, and one poorly differentiated non-small cell carcinoma. Prior to DLT, patients received radioimmunotherapy (n = 1), chemoradiotherapy (n = 2), chemoradiotherapy plus immunotherapy (IO) (n = 2), radiotherapy alone (n = 2), and chemotherapy alone (n = 3). The duration of IO was a median of 2 (2-18) months. The IO-free interval was 11, 27, and 44 months before DLT. All patients had high oxygen requirements before DLT. The indications for DLT were COPD (n = 4), IO- related ILD (n = 3), IPF (n = 2), and COVID-related ILD (n = 1). Transplant rejection did not occur, and there was no requirement for oxygen therapy for any patient. The median duration of follow-up for survival after transplant was 9 (7-17) months. Conclusions: 14 patients successfully underwent DLT for non-malignant indications of respiratory failure with less than a 5-year history of cancer without significant complications. Ongoing DREAM study cohort C will continue to investigate the role of DLT in patients with a recent history of malignancy. Clinical trial information: NCT05671887 .