A similar experience has been reported in the liver transplant population. Indeed, several studies have shown that selected patients presenting with early stage hepatocel- lular carcinoma can be cured with liver transplantation.11,12 In contrast, rapid recurrence and subsequent death was observed in patients with more advanced stages defined by the size and the number of tumors in the liver.11 Hence, the tumor stage appears to be directly related to the rate of recurrence after both liver and lung transplantation, and patients with early stage disease appears to have a good prognosis despite immunosuppression.
We identified 26 patients who underwent 29 lung transplantations for advanced multifocal BAC. All these patients had diffuse pulmonary involvement precluding any other type of surgical resection than lung transplanta- tion. Tumor recurrence developed in 13 patients surviving the transplant procedure. Interestingly, in contrast to other bronchogenic carcinomas, the recurrence was limited to the transplanted lung in most patients and was slow growing despite immunosuppresion. Similar findings were observed in the seven patients with incidentally discovered multifocal BAC in the explanted lung at the time of transplantation. Hence, lung transplantation for multifocal BAC is unlikely curative, even if incidentally discovered in the explanted lung. However, a 5-year survival of 39% appears relatively good considering