How Important is Coronary Artery Disease when Considering Lung Transplant Candidates?
Background Coronary artery disease (CAD) remains a relative contraindication for lung transplantation, but should it be if amenable to effective palliation? Methods From January 2005 to July 2010, 356 adults undergoing primary lung transplantation had no significant ( .8), and early longitudinal pos...
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| Veröffentlicht in: | The Journal of heart and lung transplantation 2016-12, Vol.35 (12), p.1453-1461 |
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| container_title | The Journal of heart and lung transplantation |
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| creator | Koprivanac, Marijan, MD, MS Budev, Marie M., DO, MPH Yun, James J., MD, PhD Kelava, Marta, MD, MS Pettersson, Gösta B., MD, PhD McCurry, Kenneth R., MD Johnston, Douglas R., MD Mangi, Abeel A., MD Houghtaling, Penny L., MS Blackstone, Eugene H., MD Murthy, Sudish C., MD, PhD |
| description | Background Coronary artery disease (CAD) remains a relative contraindication for lung transplantation, but should it be if amenable to effective palliation? Methods From January 2005 to July 2010, 356 adults undergoing primary lung transplantation had no significant ( .8), and early longitudinal post-transplant pulmonary function ( P= .2) were similar, as was time-related mortality: 20% vs. 22% and 51% vs. 52% at 1 and 4 years, respectively ( P =.6). Unmatched no-CAD patients had fewer comorbidities and lower mortality than matched patients (15% and 39% at 1 and 4 years, respectively; P= .01). Conclusions CAD is an important risk factor in lung transplant candidates, but its influence can be minimized in experienced centers by effective palliation. Surprisingly, however, CAD is a marker for an unfavorable patient phenotype with worse than typical post-transplant survival, irrespective of whether CAD is present. |
| doi_str_mv | 10.1016/j.healun.2016.03.011 |
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Methods From January 2005 to July 2010, 356 adults undergoing primary lung transplantation had no significant (<50%) coronary arterial stenosis and 70 had significant (≥50%) CAD requiring prior or concomitant revascularization. Propensity matching on 38 pre-transplant patient characteristics identified 61 well-matched pairs (87% of possible matches) and 295 no-CAD unmatched patients to compare postoperative morbidity, graft function, and time-related pulmonary function and survival. Results Compared with no-CAD patients, those with CAD intervention were older, more likely to be male, had more comorbidities, and were more likely to have idiopathic pulmonary fibrosis. Among propensity-matched patients, 5 died in-hospital in the CAD intervention group and 6 in the no-CAD group ( P= .7). Intensive care unit stay (5 vs. 7 days), postoperative stay (14 vs. 15 days), tracheostomy requirement (12 vs. 11 patients), primary graft dysfunction scores ( P> .8), and early longitudinal post-transplant pulmonary function ( P= .2) were similar, as was time-related mortality: 20% vs. 22% and 51% vs. 52% at 1 and 4 years, respectively ( P =.6). Unmatched no-CAD patients had fewer comorbidities and lower mortality than matched patients (15% and 39% at 1 and 4 years, respectively; P= .01). Conclusions CAD is an important risk factor in lung transplant candidates, but its influence can be minimized in experienced centers by effective palliation. Surprisingly, however, CAD is a marker for an unfavorable patient phenotype with worse than typical post-transplant survival, irrespective of whether CAD is present.</description><identifier>ISSN: 1053-2498</identifier><identifier>EISSN: 1557-3117</identifier><identifier>DOI: 10.1016/j.healun.2016.03.011</identifier><identifier>PMID: 27266805</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>cardiac revascularization ; Coronary Artery Disease ; graft function ; Graft Survival ; Humans ; Lung Diseases ; Lung Transplantation ; Male ; morbidity ; Risk Factors ; Surgery ; survival</subject><ispartof>The Journal of heart and lung transplantation, 2016-12, Vol.35 (12), p.1453-1461</ispartof><rights>2016 International Society for Heart and Lung Transplantation</rights><rights>Copyright © 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-57ec611ade648fa13c737a56da1046144420fc406b08a927528f2f597932a5973</citedby><cites>FETCH-LOGICAL-c483t-57ec611ade648fa13c737a56da1046144420fc406b08a927528f2f597932a5973</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S105324981630064X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27266805$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Koprivanac, Marijan, MD, MS</creatorcontrib><creatorcontrib>Budev, Marie M., DO, MPH</creatorcontrib><creatorcontrib>Yun, James J., MD, PhD</creatorcontrib><creatorcontrib>Kelava, Marta, MD, MS</creatorcontrib><creatorcontrib>Pettersson, Gösta B., MD, PhD</creatorcontrib><creatorcontrib>McCurry, Kenneth R., MD</creatorcontrib><creatorcontrib>Johnston, Douglas R., MD</creatorcontrib><creatorcontrib>Mangi, Abeel A., MD</creatorcontrib><creatorcontrib>Houghtaling, Penny L., MS</creatorcontrib><creatorcontrib>Blackstone, Eugene H., MD</creatorcontrib><creatorcontrib>Murthy, Sudish C., MD, PhD</creatorcontrib><title>How Important is Coronary Artery Disease when Considering Lung Transplant Candidates?</title><title>The Journal of heart and lung transplantation</title><addtitle>J Heart Lung Transplant</addtitle><description>Background Coronary artery disease (CAD) remains a relative contraindication for lung transplantation, but should it be if amenable to effective palliation? Methods From January 2005 to July 2010, 356 adults undergoing primary lung transplantation had no significant (<50%) coronary arterial stenosis and 70 had significant (≥50%) CAD requiring prior or concomitant revascularization. Propensity matching on 38 pre-transplant patient characteristics identified 61 well-matched pairs (87% of possible matches) and 295 no-CAD unmatched patients to compare postoperative morbidity, graft function, and time-related pulmonary function and survival. Results Compared with no-CAD patients, those with CAD intervention were older, more likely to be male, had more comorbidities, and were more likely to have idiopathic pulmonary fibrosis. Among propensity-matched patients, 5 died in-hospital in the CAD intervention group and 6 in the no-CAD group ( P= .7). Intensive care unit stay (5 vs. 7 days), postoperative stay (14 vs. 15 days), tracheostomy requirement (12 vs. 11 patients), primary graft dysfunction scores ( P> .8), and early longitudinal post-transplant pulmonary function ( P= .2) were similar, as was time-related mortality: 20% vs. 22% and 51% vs. 52% at 1 and 4 years, respectively ( P =.6). Unmatched no-CAD patients had fewer comorbidities and lower mortality than matched patients (15% and 39% at 1 and 4 years, respectively; P= .01). Conclusions CAD is an important risk factor in lung transplant candidates, but its influence can be minimized in experienced centers by effective palliation. Surprisingly, however, CAD is a marker for an unfavorable patient phenotype with worse than typical post-transplant survival, irrespective of whether CAD is present.</description><subject>cardiac revascularization</subject><subject>Coronary Artery Disease</subject><subject>graft function</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Lung Diseases</subject><subject>Lung Transplantation</subject><subject>Male</subject><subject>morbidity</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>survival</subject><issn>1053-2498</issn><issn>1557-3117</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUU1v1DAQtRCIlsI_QChHLgnjzyQXULV8tNJKHGglbpbrTKiXrL14klb99zjawoELFz-P_N6M3xvGXnNoOHDzbtfcopuW2IhSNSAb4PwJO-Vat7XkvH1a7qBlLVTfnbAXRDsAEFKL5-xEtMKYDvQpu75I99Xl_pDy7OJcBao2Kafo8kN1nmcs8DEQOsLq_hZjeYwUBswh_qi2Szmusot0mFbtxsUhDG5G-vCSPRvdRPjqEc_Y9edPV5uLevv1y-XmfFt71cm51i16w7kb0KhudFz6VrZOm8FxUIYrpQSMXoG5gc71otWiG8Wo-7aXwhWQZ-ztse8hp18L0mz3gTxO5T-YFrK8Kz57aYwqVHWk-pyIMo72kMO--LQc7Bqo3dljoHYN1IK0JdAie_M4YbnZ4_BX9CfBQnh_JGDxeRcwW_IBo8chZPSzHVL434R_G_gpxODd9BMfkHZpybFkaLklYcF-W5e67pQbCWDUd_kbUdicfw</recordid><startdate>20161201</startdate><enddate>20161201</enddate><creator>Koprivanac, Marijan, MD, MS</creator><creator>Budev, Marie M., DO, MPH</creator><creator>Yun, James J., MD, PhD</creator><creator>Kelava, Marta, MD, MS</creator><creator>Pettersson, Gösta B., MD, PhD</creator><creator>McCurry, Kenneth R., MD</creator><creator>Johnston, Douglas R., MD</creator><creator>Mangi, Abeel A., MD</creator><creator>Houghtaling, Penny L., MS</creator><creator>Blackstone, Eugene H., MD</creator><creator>Murthy, Sudish C., MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20161201</creationdate><title>How Important is Coronary Artery Disease when Considering Lung Transplant Candidates?</title><author>Koprivanac, Marijan, MD, MS ; Budev, Marie M., DO, MPH ; Yun, James J., MD, PhD ; Kelava, Marta, MD, MS ; Pettersson, Gösta B., MD, PhD ; McCurry, Kenneth R., MD ; Johnston, Douglas R., MD ; Mangi, Abeel A., MD ; Houghtaling, Penny L., MS ; Blackstone, Eugene H., MD ; Murthy, Sudish C., MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c483t-57ec611ade648fa13c737a56da1046144420fc406b08a927528f2f597932a5973</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>cardiac revascularization</topic><topic>Coronary Artery Disease</topic><topic>graft function</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>Lung Diseases</topic><topic>Lung Transplantation</topic><topic>Male</topic><topic>morbidity</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>survival</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Koprivanac, Marijan, MD, MS</creatorcontrib><creatorcontrib>Budev, Marie M., DO, MPH</creatorcontrib><creatorcontrib>Yun, James J., MD, PhD</creatorcontrib><creatorcontrib>Kelava, Marta, MD, MS</creatorcontrib><creatorcontrib>Pettersson, Gösta B., MD, PhD</creatorcontrib><creatorcontrib>McCurry, Kenneth R., MD</creatorcontrib><creatorcontrib>Johnston, Douglas R., MD</creatorcontrib><creatorcontrib>Mangi, Abeel A., MD</creatorcontrib><creatorcontrib>Houghtaling, Penny L., MS</creatorcontrib><creatorcontrib>Blackstone, Eugene H., MD</creatorcontrib><creatorcontrib>Murthy, Sudish C., MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of heart and lung transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Koprivanac, Marijan, MD, MS</au><au>Budev, Marie M., DO, MPH</au><au>Yun, James J., MD, PhD</au><au>Kelava, Marta, MD, MS</au><au>Pettersson, Gösta B., MD, PhD</au><au>McCurry, Kenneth R., MD</au><au>Johnston, Douglas R., MD</au><au>Mangi, Abeel A., MD</au><au>Houghtaling, Penny L., MS</au><au>Blackstone, Eugene H., MD</au><au>Murthy, Sudish C., MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>How Important is Coronary Artery Disease when Considering Lung Transplant Candidates?</atitle><jtitle>The Journal of heart and lung transplantation</jtitle><addtitle>J Heart Lung Transplant</addtitle><date>2016-12-01</date><risdate>2016</risdate><volume>35</volume><issue>12</issue><spage>1453</spage><epage>1461</epage><pages>1453-1461</pages><issn>1053-2498</issn><eissn>1557-3117</eissn><abstract>Background Coronary artery disease (CAD) remains a relative contraindication for lung transplantation, but should it be if amenable to effective palliation? Methods From January 2005 to July 2010, 356 adults undergoing primary lung transplantation had no significant (<50%) coronary arterial stenosis and 70 had significant (≥50%) CAD requiring prior or concomitant revascularization. Propensity matching on 38 pre-transplant patient characteristics identified 61 well-matched pairs (87% of possible matches) and 295 no-CAD unmatched patients to compare postoperative morbidity, graft function, and time-related pulmonary function and survival. Results Compared with no-CAD patients, those with CAD intervention were older, more likely to be male, had more comorbidities, and were more likely to have idiopathic pulmonary fibrosis. Among propensity-matched patients, 5 died in-hospital in the CAD intervention group and 6 in the no-CAD group ( P= .7). Intensive care unit stay (5 vs. 7 days), postoperative stay (14 vs. 15 days), tracheostomy requirement (12 vs. 11 patients), primary graft dysfunction scores ( P> .8), and early longitudinal post-transplant pulmonary function ( P= .2) were similar, as was time-related mortality: 20% vs. 22% and 51% vs. 52% at 1 and 4 years, respectively ( P =.6). Unmatched no-CAD patients had fewer comorbidities and lower mortality than matched patients (15% and 39% at 1 and 4 years, respectively; P= .01). Conclusions CAD is an important risk factor in lung transplant candidates, but its influence can be minimized in experienced centers by effective palliation. Surprisingly, however, CAD is a marker for an unfavorable patient phenotype with worse than typical post-transplant survival, irrespective of whether CAD is present.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27266805</pmid><doi>10.1016/j.healun.2016.03.011</doi><tpages>9</tpages></addata></record> |
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| ispartof | The Journal of heart and lung transplantation, 2016-12, Vol.35 (12), p.1453-1461 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | cardiac revascularization Coronary Artery Disease graft function Graft Survival Humans Lung Diseases Lung Transplantation Male morbidity Risk Factors Surgery survival |
| title | How Important is Coronary Artery Disease when Considering Lung Transplant Candidates? |
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