The effect of prior pneumonectomy or lobectomy on subsequent lung transplantation

Lung transplantation in patients with prior lobectomy or pneumonectomy is not well understood. Using the United Network for Organ Sharing (UNOS) database, we address the impact of prior major lung resection on lung transplantation outcomes.

Retrospective review of adult lung transplants from October 1999 to December 2011 in the UNOS database identified 15,300 lung transplants; 102 patients had undergone major lung resection, defined as prior pneumonectomy (n = 22) or lobectomy (n = 80). Propensity match with nonparametric 3:1 nearest-neighbor matching algorithm adjusted for treatment-level differences. After matching, the primary outcome (90-day mortality) and secondary outcome (airway dehiscence, need for dialysis, length of stay more than 25 days) were assessed with univariable and multivariable methods. Subanalysis of pneumonectomy and lobectomy individually compared with matched nonresection patients was done in a similar manner. The Kaplan-Meier method estimated long-term survival.

After matching, no significant differences were noted between groups for recipient, donor, or operative characteristics. There were 10 double lung and 12 single lung transplants after pneumonectomy and 51 double lung and 29 single lung transplants after lobectomy. Mortality at 90 days was 13.9% (n = 14) for the resection group and 8.6% (n = 1,247) for the nonresection group (p = 0.09). After matching, a significant increase was noted in 90-day mortality (p = 0.017) and perioperative dialysis (p = 0.039) for the resection versus nonresection patients. Dialysis was significantly higher among pneumonectomy patients (p = 0.03). No long-term survival difference was observed (p = 0.514).

After propensity-matching, resection was associated with increased 90-day mortality and dialysis. Careful patient selection is necessary with patients who have undergone prior major lung resection, given their increased risk of perioperative mortality and dialysis.