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Right arrow Lung - transplantation

J Thorac Cardiovasc Surg 2005;130:538-541
© 2005 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Long-term survival in lung transplant recipients after successful preoperative coronary revascularization

Leonardo Seoane, MD * , Lee M. Arcement, MD, Vincent G. Valentine, MD, P. Michael McFadden, MD

Ochsner Multi-Organ Transplant Center, Section of Pulmonary and Critical Care Medicine, Division of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, La

Received for publication October 26, 2004; revisions received December 15, 2004; accepted for publication December 20, 2004.

* Address for reprints: Leonardo Seoane, MD, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121 (Email: lseoane{at}ochsner.org).

OBJECTIVE: Coronary artery disease is considered a contraindication to lung transplantation. We studied effect of pre-lung transplantation nonobstructive coronary artery disease and revascularized coronary artery disease on long-term lung transplant survival.

METHODS: Clinical courses of 172 lung transplant recipients from December 1990 to May 2003 were reviewed. Significant coronary artery disease, defined as left main stenosis of greater than 50% or other epicardial vessel stenosis of greater than 70%, was present in 7 patients; 6 received percutaneous coronary intervention and 1 received coronary artery bypass grafting before transplantation.

RESULTS: Groups were similar with regard to sex, race, or length of intensive care days. The group with normal coronary arteries was significantly younger than the groups with coronary artery disease. The revascularized group had a significant increase in dysrhythmias (P < .003) and 1-, 3-, and 5-year survivals of 85%, 85%, and 69%, respectively. Those with insignificant coronary artery disease (14 patients) demonstrated a 1-, 3-, and 5-year survival of 64%, 40%, and 32%, respectively. The normal coronary group (151 patients) had a 1-, 3-, and 5-year survival of 75%, 58%, and 40%, respectively. The revascularized group had a significant survival advantage compared with that of the insignificant coronary artery disease group (P < .04, log-rank test).

CONCLUSION: Long-term survival of lung transplant recipients with revascularized coronary arteries is similar to that of subjects with normal coronary arteries, despite an increased incidence of dysrhythmias. Lung transplant recipients with insignificant coronary artery disease had a worse survival than the revascularized group. More studies are needed to ascertain the cause and determine the optimal management for lung transplant recipients with insignificant coronary artery disease.






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