This prospective single-center registry study evaluated outcomes of lung transplant vs medical management alone in 98 adults with medically refractory, lung-limited, stage IV NSCLC and respiratory failure (September 2021–June 2025), and compared 1-year post-transplant survival against 306 non-cancer lung transplant recipients.
Kaplan-Meier 1-year overall survival was 100% (0 deaths) in the 17 NSCLC transplant recipients vs 40.8% (52 deaths) in the 81 medically managed patients (absolute difference 59.2 percentage points; 95% CI, 46.2–71.7). At extended follow-up (January 31, 2026), 2 of the 17 transplant recipients had died.
- Very small transplant group (n=17) yields wide confidence intervals and limits generalizability. - Non-randomized design with non-biologic barriers (not medical ineligibility) explaining why 81 patients received medical management, introducing selection bias. - Median follow-up was short (~343 days for transplant group), so longer-term oncological outcomes remain unknown.
In highly selected patients with refractory, lung-limited stage IV NSCLC and respiratory failure, lung transplant appears to dramatically improve early survival compared with medical management. Clinicians should consider referral to specialized centers for transplant eligibility evaluation, while awaiting longer-term data and quality-of-life outcomes.
