Coronary Revascularization in Lung Transplant Recipients With Concomitant Coronary Artery Disease

• Published in: American journal of transplantation Vol. 13; no. 11; pp. 2978 - 2988
• Main Authors: Castleberry, A. W., Martin, J. T., Osho, A. A., Hartwig, M. G., Hashmi, Z. A., Zanotti, G., Shaw, L. K., Williams, J. B., Lin, S. S., Davis, R. D.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Wiley 01.11.2013; Wiley Subscription Services, Inc
• Subjects: Adult; Biological and medical sciences; Cardiac disease in transplant; Cardiology. Vascular system; Cardiovascular disease; coronary artery disease; Coronary Artery Disease - etiology; Coronary Artery Disease - mortality; Coronary heart disease; Coronary vessels; Coronary Vessels - pathology; Female; Follow-Up Studies; Heart; Humans; Lung Diseases - complications; Lung Diseases - mortality; Lung Diseases - surgery; lung transplant; Lung Transplantation - adverse effects; Male; Medical sciences; Middle Aged; Mortality; Myocardial Revascularization; Postoperative Complications; Prognosis; Retrospective Studies; revascularization; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; surgery—heart, lung, transplant; Survival Rate; Transplants & implants; Young Adult; Heart; coronary artery disease; Graft(material); surgery—heart; Cardiac disease in transplant; lung transplant; Lung; Coronary artery; Cardiovascular disease; Transplantation; Homotransplantation; Respiratory system; Coronary heart disease; Concomitant disease; Treatment; Surgery; Graft; transplant; Circulatory system; Revascularization; revascularization; surgery-heart, lung, transplant
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.12435

Coronary artery disease (CAD) is not uncommon among lung transplant candidates. Several small, single‐center series have suggested that short‐term outcomes are acceptable in selected patients who undergo coronary revascularization prior to, or concomitant with, lung transplantation. Our objective was to evaluate perioperative and intermediate‐term outcomes in this patient population at our institution. We performed a retrospective, observational cohort analysis of 898 lung transplant recipients between 1997 and 2010. Pediatric, multivisceral, lobar or repeat transplantations were excluded, resulting in 791 patients for comparative analysis, of which 49 (median age 62, 79.6% bilateral transplant) underwent concurrent coronary artery bypass and 38 (median age 64, 63.2% bilateral transplant) received preoperative percutaneous coronary intervention (PCI). Perioperative mortality, overall unadjusted survival and adjusted hazard ratio for cumulative risk of death were similar among both revascularization groups as well as controls. The rate of postoperative major adverse cardiac events was also similar among groups; however, concurrent coronary artery bypass was associated with longer postoperative length of stay, more time in the intensive care unit and more postoperative days requiring ventilator support. These results suggest that patients with CAD need not be excluded from lung transplantation. Preferential consideration should be given to preoperative PCI when feasible. A retrospective, observational cohort analysis of 791 lung transplant recipients from a large volume center demonstrates that candidates for lung transplantation need not be excluded due to coronary artery disease.