July 2026

PULMONARY

LUNG TRANSPLANT SHOWS EARLY SURVIVAL IN SELECT PATIENTS WITH LUNG-LIMITED STAGE 4 NSCLC

Findings published in JAMA suggest that lung transplant may be an option for select patients with medically refractory lung-limited stage 4 non-small cell lung cancer (NSCLC). These challenge the use of stage 4 disease alone to automatically exclude patients from consideration of lung transplantation.

​Study Details
In a prospective single-center registry study at Northwestern Medicine Canning Thoracic Institute, 17 eligible participants underwent lung transplant while 81 received medical management alone.

The study evaluated outcomes from the DREAM registry, which aims to determine if replacing lungs overtaken by treatment-resistant cancer can remove organ-confined disease in patients with respiratory failure.

1-Year Post-transplant Outcomes
  • 100% for patients with NSCLC who received a lung transplant
    • Median follow-up from eligibility evaluation was 343 days 
  • 40.8% for patients with NSCLC who received only medical management
    • Median follow-up was 221 days
  • 88.1% for patients without cancer who received a lung transplant
    • Median follow-up was 200 days

Takeaways for the Transplant Medicine of Tomorrow
“This work changes what we can imagine for a highly selected group of patients who were previously considered beyond the reach of curative-intent intervention,” says Ankit Bharat, MD, co-corresponding author.

“Transplantation was embedded within a complete scientific framework — rigorous staging, proof of lung-limited disease, transplant-specific operative innovation, intensive surveillance and molecular analysis of the explanted tumors. That is what makes this a new model of transplant oncology,” adds co-corresponding author G.R. Scott Budinger, MD.
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Multicenter data and longer-term follow-up are needed. The Northwestern Medicine DREAM Program continues to accept select patients for double-lung transplantation.
Ankit Bharat, MD, served as co-corresponding author. Dr. Bharat is chief of Thoracic Surgery and the Harold L. and Margaret N. Method Professor of Surgery. He also serves as director of Northwestern Medicine Canning Thoracic Institute.
G.R. Scott Budinger, MD, was co-corresponding author. Dr. Budinger is chief of Pulmonary and Critical Care and the Ernest S. Bazley Professor of Airway Diseases.

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