Lung transplantation following coronary artery bypass surgery—improved outcomes following single-lung transplant

McKellar, Stephen H.; Bowen, Megan E.; Baird, Bradley C.; Raman, Sanjeev; Cahill, Barbara C.; Selzman, Craig H.

doi:10.1016/j.healun.2016.05.029

Cited by 27 publications

(24 citation statements)

References 8 publications

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“…This is consistent with previous studies where the risk of early complications was higher among patients with a history of prior thoracic surgery . Although the long‐term survival did not seem to be impacted in some of the studies, more recent studies on larger cohorts found that history of coronary artery bypass grafting (CABG) was strongly associated with significantly increased mortality especially after bilateral LT . Interestingly, the increased risk of mortality was not seen after a single right or single left LT in this study.…”

Section: Discussionsupporting

confidence: 92%

Incidence and variables associated with 30‐day mortality after lung transplantation

Banga

Mohanka

Mullins

et al. 2019

Clinical Transplantation

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Background:With the introduction of the lung allocation score (LAS), sicker patients are prioritized for lung transplantation (LT). There is a lack of data regarding variables independently associated with 30-day mortality after LT. Methods:We queried the UNOS database for adult patients undergoing LT between 1989 and 2014. Patients with dual organ or previous transplantation and those with missing survival data were excluded. Mortality during the first 30 days after LT was the primary outcome variable. Results:The yearly trends indicate a statistically significant reduction in the 30-day mortality during the study period (P < 0.001, overall mortality: 5.5%) which has continued in the post-LAS era (P = 0. 014, overall mortality: 3.6%). Among patients with 30-day mortality, "primary non-function" (n = 118, 72.8%) was reported as the most common etiology. Transplant indication of vascular diseases, history of non-transplant cardiac or lung surgery, mean pulmonary pressures >35 mm Hg, disabled functional status, ECMO support, high LAS, ischemic time >6 hours, and blunt injury as the mechanism of donor death are independently associated with 30-day mortality. Conclusion:The incidence of early mortality after LT continues to decline in the post-LAS era. Apart from the mechanism of donor death and ischemic time, early mortality appears to be primarily driven by the recipient characteristics. K E Y W O R D S30-day survival, ECMO, ischemic time, need of dialysis, postoperative mortality

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Section: Discussionsupporting

confidence: 92%

Incidence and variables associated with 30‐day mortality after lung transplantation

Banga

Mohanka

Mullins

et al. 2019

Clinical Transplantation

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“…The presence or absence of CAD could be included as a variable on the UNOS data sheet and therefore be examined with nationally powered statistics. A good example of a nationally powered study is the analysis by McKellar et al, which showed that patients who previously underwent CABG followed by an LT had worse survival at 5 years (HR, 2.54; P < 0.01).…”

Section: Discussionmentioning

confidence: 99%

“…Several single‐center studies have shown that the presence of CAD in LT recipients does not increase the rate of perioperative cardiac events or significantly alter survival . Only a few studies have shown an increase in perioperative cardiovascular events or a change in survival . The United Network for Organ Sharing (UNOS) gathers data about previous cardiac surgical procedures such as coronary artery bypass grafting (CABG) but does not record the presence or absence of CAD or the presence of prior stenting.…”

Section: Introductionmentioning

confidence: 99%

Lung transplant patients with coronary artery disease rarely die of cardiac causes

Makey

Sui

Huynh

et al. 2018

Clinical Transplantation

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“…While I agree that prior PCI or CABG alone should not preclude transplant candidacy, we should take these prior interventions into account when discussing multiple comorbidities in the elderly patients with lung transplantation. One recent largest retrospective study using the United Network for Organ Sharing Standard Transplant Analysis and Research database suggests that perhaps patients with prior CABG should be candidates only for single lung transplant , which is basically in line with our current strategy where the option for single lung transplant is also prioritized for those elderly patients who need concurrent CABG because of their severe CAD that precludes a PCI option with dual antiplatelet therapy because of their closing window for transplantation.…”

Section: Review Of the Literaturementioning

confidence: 72%

Elderly patients with multiple comorbidities: insights from the bedside to the bench and programmatic directions for this new challenge in lung transplantation

Shigemura

Toyoda

2019

Transpl Int

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Summary In aging populations, many patients have multiple diseases characterized by acceleration of the aging process including cardiovascular diseases, metabolic diseases, and chronic kidney disease. Remarkable progress in minimally invasive, interventional therapies, such as percutaneous coronary intervention and transcatheter aortic valve replacement has enabled patients who were previously not transplant candidates because of co‐existing problems to become potentially viable candidates for lung transplantation. Recently, we have observed an outstanding and steady increase in patients older 70 years of age with multiple comorbidities who are referred to our high‐volume center as potential candidates for lung transplantation. However, the impact of diseases characterized by an accelerated aging process and their treatments on transplant outcomes remains unclear. This review aims to highlight these challenges in the current era of lung transplantation, review the prior literature, and discuss future directions with a multidisciplinary view including translational research, transplant medicine, and surgery, as well as from a programmatic and administrative standpoint.

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Lung transplantation following coronary artery bypass surgery—improved outcomes following single-lung transplant

Cited by 27 publications

References 8 publications

Incidence and variables associated with 30‐day mortality after lung transplantation

Incidence and variables associated with 30‐day mortality after lung transplantation

Lung transplant patients with coronary artery disease rarely die of cardiac causes

Elderly patients with multiple comorbidities: insights from the bedside to the bench and programmatic directions for this new challenge in lung transplantation

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