Lung Volume Reduction Followed by Lung Transplantation in Emphysema—A Multicenter Matched Analysis

Slama, Alexis; Ceulemans, Laurens J.; Hedderich, Celia; Boehm, Panja M.; Slambrouck, Jan Van; Schwarz, Štefan; Vandervelde, C.; Kamler, Markus; Jaksch, Péter; Raemdonck, Dirk Van; Höetzenecker, Konrad; Aigner, Clemens

doi:10.3389/ti.2022.10048

Cited by 7 publications

(3 citation statements)

References 28 publications

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“…So far, eLVR has not been associated with an increased perioperative risk. In previous studies, however, eVLR was associated with an increased incidence of wound infection [13] and post-transplant airway colonization [8]. While we also noted a slightly increased rate of wound infection in our patients after eLVR, this did not reach statistical significance.…”

Section: Discussioncontrasting

confidence: 82%

“…To our knowledge, there is very little data on the effect of eLVR as a bridge to LTx [5, 12]. While there are studies reporting that the outcome after LVRS and eLVR as a bridge to transplant is largely similar [5, 6, 13], there are others reporting that LVRS can negatively impact survival [3, 29] or increase the perioperative risk [30].…”

Section: Discussionmentioning

confidence: 99%

“…For some patients undergoing eLVR, however, the beneficial effect is only temporary. With progressive respiratory failure, LTx remains the last resort [13]. In case of eLVR prior to LTx, the patients are older when joining the waiting list, and relevant comorbidities might develop or even progress.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Lung Volume Reduction Prior to Lung Transplantation Does Not Increase Postoperative Pulmonary Complications

Kornyeva,

Semmelmann,

Ogutur

et al. 2023

Respiration

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Introduction: Lung transplantation (LTx) remains the only therapeutic option for selected patients with end-stage lung disease. In comparison to surgical lung volume reduction, few data exist on the risks and benefits of pretransplant endoscopic lung volume reduction (eLVR). Here, we investigate the risk of postoperative pulmonary complications (PPCs) after LTx in patients with emphysematous lung disease bridged with eLVR until transplantation. Methods: Eighty-two patients with emphysematous lung disease who underwent double-LTx (DLTx) were included and retrospectively evaluated. Statistical analysis was performed using SPSS and GraphPad Prism software. Results: 28/82 patients underwent eLVR prior to DLTx. eLVR patients spent comparable time on the waitlist; however, they were older at the time of DLTx (median 60 vs. 58 years, p = 0.02). Both groups showed comparable 90-day (92%) and long-term survival (eLVR 1-/5-/10-year survival: 92/88/77%, vs. control: 89/77/67%, p = 0.5). The odds for PPCs were similar in patients with and without eLVR (OR 0.7; 95% CI: 0.3–1.7), as well as major perioperative surgical and cardiovascular complications. In the entire cohort, we found ≥1 PPC to be a risk factor for death within 90 days (OR 9.7, 95% CI: 1.3–110). Among the PPCs, pneumonia (HR 4.6 95% CI: 1.1–14.9, p = 0.02) and ARDS (HR 11.2 95% CI: 1.6–229.2, p = 0.04) were identified as independent risk factors for reduced long-term survival. Conclusions: eLVR does not increase the risk for PPCs, surgical complications, or reduced survival after LTx in patients with emphysematous lung disease and can serve as a bridge to LTx.

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Section: Discussioncontrasting

confidence: 82%