Lung transplantation in patients who have undergone prior cardiothoracic procedures

Background Patients who have undergone prior cardiothoracic procedures offer technical challenges that may affect post-transplant outcomes and be a reason to decline listing. Currently, data are limited regarding the indication for lung transplantation among recipients who have had prior cardiothoracic procedures. Methods Of 453 lung transplants performed at Cleveland Clinic from January 2005 to July 2010, 206 recipients (45%) had undergone prior cardiothoracic procedures: 157 lung only, 15 cardiac only, 10 cardiac+lung, 10 pleurodesis+lung, and 14 other. Chest tube placement was performed in 202. Survival, post-transplant length of intensive care unit (ICU) and hospital stays, primary graft dysfunction, and pulmonary function were compared with those of patients not having prior procedures using propensity-score adjustment. Results Short- and long-term survival was similar between the 2 groups: Survival at 30 days, 1 year, and 5 years was 94%, 83%, and 55% for the prior cardiothoracic procedure group and 96%, 84%, and 53% for the no-prior cardiothoracic procedure group ( p[log-rank]=. 9), respectively. ICU stay was longer (6 vs. 5 days, p =.02) in the prior cardiothoracic procedure group, and this was particularly true of the pleurodesis+lung combination (10 days, p =.05), although post-transplant hospital stay was similar (16, 16, and 22 days, respectively; p =.13). Primary graft dysfunction was not increased in the prior cardiothoracic procedure group. Forced expiratory volume in 1 second was similar for both, but lower for thoracotomy and lung procedures using a bilateral chest tube ( p