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Outcomes in lung transplantation after previous lung volume reduction surgery in a contemporary cohort

Published:February 07, 2014DOI:https://doi.org/10.1016/j.jtcvs.2014.01.045

      Objectives

      Lung volume reduction surgery (LVRS) provides palliation and improved quality of life in select patients with end-stage chronic obstructive pulmonary disease (COPD). The effect of previous LVRS on lung transplant outcomes has been inadequately studied. We report our experience in the largest single institution series of these combined procedures.

      Methods

      The records of 472 patients with COPD undergoing lung transplantation or LVRS between 1995 and 2010 were reviewed. Outcomes of patients undergoing transplant after LVRS were compared with outcomes of patients undergoing transplant or LVRS alone. Survival was compared using log-rank tests and the Kaplan-Meier method.

      Results

      Demographics, comorbidities, and spirometry were similar at the time of transplantation. Patients who had undergone lung transplant after LVRS had longer transplant operative times (mean 4.4 vs 5.6 hours; P = .020) and greater hospital length of stay (mean 17.6 vs 29.1 days; P = .005). Thirty-day mortality and major morbidity were similar. Posttransplant survival was reduced for transplant after LVRS (median, 49 months; 95% confidence interval [CI], 16, 85 months) compared with transplant alone (median, 96 months; 95% CI, 82, 106 months; P = .008). The composite benefit of combined procedures, defined as bridge from LVRS to transplant of 55 months and posttransplant survival of 49 months (total 104 months), was comparable with survival of patients undergoing either procedure alone.

      Conclusions

      Lung transplant after LVRS leads to minimal additional perioperative risk. The reduced posttransplant survival in patients undergoing combined procedures is in contradistinction to reports from other smaller series. When determining the best surgical treatment for patients with more severe disease, the benefit of LVRS before transplant should be weighed against the consequence of reduced posttransplant survival.

      CTSNet classification

      Abbreviations and Acronyms:

      COPD (chronic obstructive pulmonary disease), CI (confidence interval), FEV1 (forced expiratory volume in 1 second), ICU (intensive care unit), LAS (lung allocation score), LVRS (lung volume reduction surgery), NETT (National Emphysema Treatment Trial), PFT (pulmonary function tests), PVR (pulmonary vascular resistance), RV (residual volume), SD (standard deviation)
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