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Published on: October 11, 2024
Lung transplantation following coronary artery bypass surgery-improved outcomes following single-lung transplant
Stephen H McKellar1, Megan E Bowen1, Bradley C Baird2
1Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
Insights
Lung transplantation (LTx) after coronary artery bypass grafting (CABG) is uncommon but increasing. Prior CABG independently predicts mortality, especially for bilateral LTx, impacting long-term survival.
Area of Science:
- Cardiology
- Thoracic Surgery
- Transplant Surgery
Background:
- Prior coronary artery bypass grafting (CABG) was a contraindication for lung transplantation (LTx).
- Increasing referrals and LTx in patients with prior CABG necessitate re-evaluation of this contraindication.
- The study aimed to determine the prevalence and outcomes of LTx in patients with a history of CABG.
Approach:
- Analysis of the United Network for Organ Sharing Standard Transplant Analysis and Research data set (2004-2013).
- Inclusion of adult LTx patients with mandatory reporting of prior CABG status.
- Evaluation of 30-day, 1-year, 3-year, and 5-year survival rates as primary endpoints.
Key Points:
- 2% of 14,791 LTx patients (292) had prior CABG, most commonly single right LTx.
- Overall survival rates were 97% at 30 days, 88% at 1 year, 79% at 3 years, and 74% at 5 years.
- Prior CABG was a significant predictor of mortality across all time points (HR 1.38-1.97).
Conclusions:
- LTx after CABG is uncommon but increasingly performed.
- Prior CABG is an independent predictor of mortality in LTx recipients.
- Increased mortality associated with prior CABG is driven by bilateral LTx recipients.
Background:
Prior coronary artery bypass grafting (CABG) has been a contraindication to lung transplantation (LTx) because of disease severity and technical considerations. Although patients increasingly are being referred for and receiving LTx, whether it should remain a contraindication is unknown. We sought to define the prevalence of LTx after CABG and determine the effect on outcomes.
Methods:
The United Network for Organ Sharing Standard Transplant Analysis and Research data set was queried during the period 2004-2013 for adult LTx patients, as prior CABG became a mandatory reporting field in 2004. The primary end-points were 30-day and 1-, 3-, and 5-year survivals.
Results:
The study cohort included 14,791 patients, of whom 292 patients had previously undergone CABG (single left, n = 68; single right, n = 181; bilateral, n = 43), representing 2% of all transplants. For the entire cohort, 30-day survival was 97%, and survival at 1, 3, and 5 years was 88%, 79%, and 74%. CABG was a predictor of mortality at all time points, with hazard ratios ranging from 1.97 (confidence interval, 1.23-3.16; p < 0.01) at 30 days to 1.38 (confidence interval, 1.12-1.69; p < 0.01) at 5 years. When stratified by type of transplant, CABG strongly predicted mortality at all time points for patients receiving bilateral, but not single, transplants.
Conclusions:
Although LTx after CABG is uncommon, it is increasingly performed in the current era. Single right LTx is the most common procedure performed in patients with prior CABG. CABG before LTx is an independent predictor of mortality at all time points and is driven by increased mortality in patients receiving bilateral LTx.
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