Question: I have a 63-year-old male patient with IPF who is on oxygen therapy. He has been turned down by our regional transplant center for a lung transplant because he had lung cancer 3 years ago. His left lung was removed and he has been disease free since then. What is the rationale for excluding him from the transplant list?

Answer: All transplant programs exclude patients with potential contraindications from the transplantation list. Cancer is a contraindication to lung transplantation for 2 reasons. First, not enough time has passed to be confident of no recurrence. This window is generally 2 years, but longer in some instances such as lung cancer, where the recommended waiting time is 5 years. The second reason is that transplantation requires immunosuppression to prevent rejection of the lung. Immunosuppression increases the likelihood that residual cancer cells will proliferate and spread. Therefore, the transplant and immune suppression might do more harm than good by enabling the uncontrolled spread of the malignancy.