PURPOSE: Do prior cardiothoracic procedures adversely affect the outcome of subsequent lung transplantation (LTx)? How much strictly should the indication for LTx with the procedures be considered?.
METHODS: A retrospective review of all 554 lung transplantation cases between 2004 and 2009 was performed. Patients who had cardiothoracic surgical procedures prior to their LTx (CTS group, n=238) were compared with those who underwent LTx without the procedures (Non-CTS group, n=316). CTS procedures included all the CTS related procedures such as cardiac (n=33; CABG, valve, etc), thoracic surgery (n=50; lung resection, bullectomy, etc), pleurodesis (n=46; surgical and chemical), and chest drain insertion alone (n=115). Patient characteristics and all outcome variables were retrieved. Four subgroups of patients in CTS group were analyzed for in-hospital morbidity and mid-term graft quality. In addition, preoperative computed tomography findings were reviewed and correlated with operative records to investigate whether the radiographic assessment may help predict the technical difficulties at the time of surgery.
RESULTS: Postoperative respiratory complications and renal dysfunction requiring dialysis were higher in CTS group whereas long-term survival was not significantly different between CTS and Non-CTS groups. Pulmonary functional improvement after 6 months was worse in CTS group in view of FEV1 increase (28.8% vs. 49.2%, p<0.05). Among the subgroups, chemical pleurodesis group (n=23) was significantly associated with major adverse post-transplant events (OR, 1.7; CI, 1.4-2.0; p<0.005), whereas cardiac surgery, thoracic surgery and chest drain insertion groups were not. Both chemical and surgical groups were significantly associated with worse mid-term graft quality as well. Preoperative computed tomography findings were suggestive of technical difficulties due to severe symphysis encountered at the time of explanting the native lungs, specifically in the pleurodesis group (sensitivity, 89%; specificity 95%).
CONCLUSION: Prior cardiothoracic procedures alone should not be the contraindication for LTx.
CLINICAL IMPLICATIONS: Concerning the cases with prior pleurodesis procedures, more meticulous discussion in terms of the advantages and disadvantages related to the transplantation, specifically in the long-term graft quality should be done prior to deciding the indication for them.
DISCLOSURE: Norihisa Shigemura, No Financial Disclosure Information; No Product/Research Disclosure Information