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Poster Presentations: Wednesday, October 26, 2011 |

Coronary Artery Disease and the LAS: Searching for the Outliers FREE TO VIEW

William Ragalie, BS; Nilto DeOliveira, MD; Richard Cornwell, MD; Keith Meyer, MD; Meghan Holland, BS; James Maloney, MD
Chest. 2011;140(4_MeetingAbstracts):669A. doi:10.1378/chest.1118170
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Abstract

PURPOSE: Lung transplant remains a high risk therapy with survival significantly less than other organ transplant. LAS has changed the population undergoing lung transplant and has resulted in decreased survival as demonstrated in the SRTR. Idiopathic pulmonary fibrosis (IPF) is now the most common diagnosis and patients are older than previous. Coronary artery disease (CAD) is a relative contraindication to lung transplant, an independent risk factor for death in elderly lung transplant recipients (1), but does not preclude listing. IPF is linked to higher prevalence of CAD and DVT(2). We reviewed our transplant database to assess the impact of CAD in our program since LAS.

METHODS: Retrospective review of an approved database. CAD was determined by the patient’s medical record. Patients since the institution of LAS (5/2005) and pre-LAS (2000-2004)were divided into groups based on the presence of CAD. 1, 3 and 5 year survival rates were compared between CAD groups and those without CAD. Prevalence of CAD was assessed by indication for pulmonary transplantation in the post-LAS era and compared to the pre-LAS era.

RESULTS: In the pre-LAS era, 5.3% (7 of 131) patients had a diagnosis of CAD, 10.6% (18 of 170) in the post-LAS era (two-tailed p value = 0.14). In the post-LAS era, 50% (9 of 18) of transplanted patients with CAD had COPD, 38.7% (7 of 18) with IPF. 1, 3, and five year survival rates for patients without CAD were 83.6% (95% CI 76.6-89.0), 72.5% (64.6-79.3), and 53.8% (45.6-61.8), respectively. Patients with documented CAD had 1, 3 and 5 year survival rates of 66.7% (41.1-85.6), 61.1% (36.1-81.7), and 40.7% (19.6-65.5), respectively. Univariate analysis showed CAD to confer a relative risk of death of 2.04 (95% CI 0.80-4.16, p = 0.15).

CONCLUSIONS: LAS did not change the prevalence of CAD in patients who underwent lung transplantation at our institution. Patients who did have a history of CAD more often had a diagnosis of COPD than IPF as their indication for transplant, showing differences from population level data. Though not reaching statistical significance, the lower survival rates among patients with CAD are noteworthy given the small number represented. Further research can address which CAD patients benefit the most from pulmonary transplantation.

CLINICAL IMPLICATIONS: Though these data do not suggest CAD to be an absolute contraindication to lung transplantation, the trend towards increased mortality supports judicious pre-transplant evaluation in this subgroup.

DISCLOSURE: The following authors have nothing to disclose: William Ragalie, Nilto DeOliveira, Richard Cornwell, Keith Meyer, Meghan Holland, James Maloney

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