Lung Volume Reduction Surgery Before Lung Transplantation: A Propensity-Matched Analysis

Area of Science:

• Pulmonary Medicine
• Transplant Surgery
• Critical Care Medicine

Background:

• Lung volume reduction surgery (LVRS) is a treatment for chronic obstructive pulmonary disease (COPD).
• COPD is a leading indication for lung transplantation (LTx).
• The efficacy and safety of LVRS prior to LTx remain controversial, with conflicting single-institution study results.

Purpose of the Study:

• To investigate the impact of undergoing LVRS before LTx on post-transplant outcomes.
• To determine if LVRS influences graft failure rates in patients receiving LTx for COPD.

Main Methods:

• A retrospective analysis of the United Network for Organ Sharing database.
• Inclusion of adult patients undergoing first-time LTx for COPD during the lung allocation score era.
• Propensity matching was used to compare patients who underwent LVRS before LTx with those who did not.

Main Results:

• A total of 4905 patients underwent LTx; 107 (2.2%) had prior LVRS.
• Propensity matching created 106 pairs of LVRS+LTx and LTx-only patients.
• Median survival was significantly longer in the LTx-only group (6.5 vs. 3.4 years).
• LVRS before LTx was associated with a 72% increased risk of graft failure (HR 1.72; P=.01).

Conclusions:

• LVRS prior to LTx is associated with significantly increased graft failure risk.
• Patients undergoing LVRS who subsequently require LTx need careful pre-transplant assessment.
• Close postoperative monitoring is recommended for patients who have undergone LVRS before LTx.