Abstract Rationale Lung cancer (LC) developing in the native lung after single-lung transplantation (SLT) remains poorly understood. Although smoking and emphysema are recognized risk factors, progressive fibrosis may also contribute to carcinogenesis. This study used automated quantitative CT analysis to explore whether progression of native-lung fibrosis or emphysema differs between SLT recipients who developed LC and matched controls without LC. Methods We retrospectively identified SLT recipients (2016–2024) from a single high-volume transplant center who developed LC and selected 1:1 matched controls by sex, indication for transplant, and laterality. For each patient, quantitative CT analysis of the native lung was performed using Coreline software on two time points: the most recent pre-transplant scan and the scan preceding LC diagnosis (or equivalent interval in controls). Parameters included low-attenuation area ≤ –950 HU (LAA-950 %, emphysema), lung texture patterns (N = normal, G = ground-glass, R = reticulation, H = honeycombing), and interstitial-lung-abnormality (ILA) metrics (total and fibrotic %). Differences between groups and longitudinal changes (Δ) were compared using Mann–Whitney U testing (p 0.05 significant). Results Forty-eight SLT recipients (24 LC, 24 controls) met inclusion criteria, with a median interval of 3.5 years between CT scans. Baseline characteristics were similar except for greater smoking exposure and chronic kidney disease in LC cases. Quantitative findings are summarized in Table 1. No variable reflecting fibrotic progression differed significantly between LC and control groups. On univariate analysis, pre-LC scans in the pulmonary-fibrosis subgroup showed lower ground-glass (Pattern G) and higher normal (Pattern N) parenchymal percentages in LC patients; these associations were not significant on multivariate regression. In the emphysema subgroup, Δ LAA-950 % was paradoxically lower in LC patients (1.25 ± 14.35 vs 11.63 ± 13.72, p = 0.05). Conclusions Among SLT recipients, neither fibrotic nor emphysematous progression of the native lung predicted subsequent lung cancer. These findings likely reflect sample-size limitations, retrospective design, and the exploratory nature of Coreline-derived metrics. More studies are needed to explore the role of progressive fibrosis in carcinogenesis after lung transplantation. This abstract is funded by: None
Albaba et al. (Fri,) studied this question.