The role of coronary artery disease in lung transplantation: a propensity-matched analysis.

Cardiovascular evaluation Coronary artery disease Extracorporeal membrane oxygenation Lung transplantation Revascularization Transplant candidate selection

Journal

Clinical research in cardiology : official journal of the German Cardiac Society

ISSN: 1861-0692

Titre abrégé: Clin Res Cardiol

Pays: Germany

ID NLM: 101264123

Informations de publication

Date de publication:
08 Apr 2024

Historique:

received: 05 12 2023

accepted: 26 03 2024

medline: 8 4 2024

pubmed: 8 4 2024

entrez: 8 4 2024

Statut: aheadofprint

Résumé

Candidate selection for lung transplantation (LuTx) is pivotal to ensure individual patient benefit as well as optimal donor organ allocation. The impact of coronary artery disease (CAD) on post-transplant outcomes remains controversial. We provide comprehensive data on the relevance of CAD for short- and long-term outcomes following LuTx and identify risk factors for mortality. We retrospectively analyzed all adult patients (≥ 18 years) undergoing primary and isolated LuTx between January 2000 and August 2021 at the LMU University Hospital transplant center. Using 1:1 propensity score matching, 98 corresponding pairs of LuTx patients with and without relevant CAD were identified. Among 1,003 patients having undergone LuTx, 104 (10.4%) had relevant CAD at baseline. There were no significant differences in in-hospital mortality (8.2% vs. 8.2%, p > 0.999) as well as overall survival (HR 0.90, 95%CI [0.61, 1.32], p = 0.800) between matched CAD and non-CAD patients. Similarly, cardiovascular events such as myocardial infarction (7.1% CAD vs. 2.0% non-CAD, p = 0.170), revascularization by percutaneous coronary intervention (5.1% vs. 1.0%, p = 0.212), and stroke (2.0% vs. 6.1%, p = 0.279), did not differ statistically between both matched groups. 7.1% in the CAD group and 2.0% in the non-CAD group (p = 0.078) died from cardiovascular causes. Cox regression analysis identified age at transplantation (HR 1.02, 95%CI [1.01, 1.04], p < 0.001), elevated bilirubin (HR 1.33, 95%CI [1.15, 1.54], p < 0.001), obstructive lung disease (HR 1.43, 95%CI [1.01, 2.02], p = 0.041), decreased forced vital capacity (HR 0.99, 95%CI [0.99, 1.00], p = 0.042), necessity of reoperation (HR 3.51, 95%CI [2.97, 4.14], p < 0.001) and early transplantation time (HR 0.97, 95%CI [0.95, 0.99], p = 0.001) as risk factors for all-cause mortality, but not relevant CAD (HR 0.96, 95%CI [0.71, 1.29], p = 0.788). Double lung transplant was associated with lower all-cause mortality (HR 0.65, 95%CI [0.52, 0.80], p < 0.001), but higher in-hospital mortality (OR 2.04, 95%CI [1.04, 4.01], p = 0.039). In this cohort, relevant CAD was not associated with worse outcomes and should therefore not be considered a contraindication for LuTx. Nonetheless, cardiovascular events in CAD patients highlight the necessity of control of cardiovascular risk factors and a structured cardiac follow-up.

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE

METHODS METHODS

We retrospectively analyzed all adult patients (≥ 18 years) undergoing primary and isolated LuTx between January 2000 and August 2021 at the LMU University Hospital transplant center. Using 1:1 propensity score matching, 98 corresponding pairs of LuTx patients with and without relevant CAD were identified.

RESULTS RESULTS

Among 1,003 patients having undergone LuTx, 104 (10.4%) had relevant CAD at baseline. There were no significant differences in in-hospital mortality (8.2% vs. 8.2%, p > 0.999) as well as overall survival (HR 0.90, 95%CI [0.61, 1.32], p = 0.800) between matched CAD and non-CAD patients. Similarly, cardiovascular events such as myocardial infarction (7.1% CAD vs. 2.0% non-CAD, p = 0.170), revascularization by percutaneous coronary intervention (5.1% vs. 1.0%, p = 0.212), and stroke (2.0% vs. 6.1%, p = 0.279), did not differ statistically between both matched groups. 7.1% in the CAD group and 2.0% in the non-CAD group (p = 0.078) died from cardiovascular causes. Cox regression analysis identified age at transplantation (HR 1.02, 95%CI [1.01, 1.04], p < 0.001), elevated bilirubin (HR 1.33, 95%CI [1.15, 1.54], p < 0.001), obstructive lung disease (HR 1.43, 95%CI [1.01, 2.02], p = 0.041), decreased forced vital capacity (HR 0.99, 95%CI [0.99, 1.00], p = 0.042), necessity of reoperation (HR 3.51, 95%CI [2.97, 4.14], p < 0.001) and early transplantation time (HR 0.97, 95%CI [0.95, 0.99], p = 0.001) as risk factors for all-cause mortality, but not relevant CAD (HR 0.96, 95%CI [0.71, 1.29], p = 0.788). Double lung transplant was associated with lower all-cause mortality (HR 0.65, 95%CI [0.52, 0.80], p < 0.001), but higher in-hospital mortality (OR 2.04, 95%CI [1.04, 4.01], p = 0.039).

CONCLUSION CONCLUSIONS

In this cohort, relevant CAD was not associated with worse outcomes and should therefore not be considered a contraindication for LuTx. Nonetheless, cardiovascular events in CAD patients highlight the necessity of control of cardiovascular risk factors and a structured cardiac follow-up.

Identifiants

DOI: 10.1007/s00392-024-02445-y PMID: 38587564

pubmed: 38587564

doi: 10.1007/s00392-024-02445-y

pii: 10.1007/s00392-024-02445-y

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Informations de copyright

Références

GBD Chronic Respiratory Disease Collaborators (2020) Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Respir Med 8(6):585–596. https://doi.org/10.1016/s2213-2600(20)30105-3

doi: 10.1016/s2213-2600(20)30105-3

Nishimura K, Tsukino M (2000) Clinical course and prognosis of patients with chronic obstructive pulmonary disease. Curr Opin Pulm Med 6(2):127–132. https://doi.org/10.1097/00063198-200003000-00008

doi: 10.1097/00063198-200003000-00008 pubmed: 10741772

Glass DS, Grossfeld D, Renna HA, Agarwala P, Spiegler P, DeLeon J et al (2022) Idiopathic pulmonary fibrosis: Current and future treatment. Clin Respir J 16(2):84–96. https://doi.org/10.1111/crj.13466

doi: 10.1111/crj.13466 pubmed: 35001525 pmcid: 9060042

Holm AM, Immer F, Benden C (2020) Lung allocation for transplant: The European perspective. Clin Transplant 34(7):e13883. https://doi.org/10.1111/ctr.13883

doi: 10.1111/ctr.13883 pubmed: 32294267

Lewis A, Koukoura A, Tsianos GI, Gargavanis AA, Nielsen AA, Vassiliadis E (2021) Organ donation in the US and Europe: The supply vs demand imbalance. Transplant Rev (Orlando) 35(2):100585. https://doi.org/10.1016/j.trre.2020.100585

doi: 10.1016/j.trre.2020.100585 pubmed: 33071161

Jones RM, Enfield KB, Mehrad B, Keeley EC (2014) Prevalence of obstructive coronary artery disease in patients undergoing lung transplantation: case series and review of the literature. Catheter Cardiovasc Interv 84(1):1–6. https://doi.org/10.1002/ccd.25261

doi: 10.1002/ccd.25261 pubmed: 24136925

Reed RM, Eberlein M, Girgis RE, Hashmi S, Iacono A, Jones S et al (2012) Coronary artery disease is under-diagnosed and under-treated in advanced lung disease. Am J Med 125(12):1228.e13-e22. https://doi.org/10.1016/j.amjmed.2012.05.018

doi: 10.1016/j.amjmed.2012.05.018

Nations JA, Nathan SD (2009) Comorbidities of advanced lung disease. Mt Sinai J Med 76(1):53–62. https://doi.org/10.1002/msj.20086

doi: 10.1002/msj.20086 pubmed: 19170218

Smith MC, Wrobel JP (2014) Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulmon Dis 9:871–888. https://doi.org/10.2147/copd.S49621

doi: 10.2147/copd.S49621 pubmed: 25210449 pmcid: 4154888

Manoushagian S, Meshkov A (2014) Evaluation of solid organ transplant candidates for coronary artery disease. Am J Transplant 14(10):2228–2234. https://doi.org/10.1111/ajt.12915

doi: 10.1111/ajt.12915 pubmed: 25220486

Huiart L, Ernst P, Suissa S (2005) Cardiovascular morbidity and mortality in COPD. Chest 128(4):2640–2646. https://doi.org/10.1378/chest.128.4.2640

doi: 10.1378/chest.128.4.2640 pubmed: 16236937

Kizer JR, Zisman DA, Blumenthal NP, Kotloff RM, Kimmel SE, Strieter RM et al (2004) Association between pulmonary fibrosis and coronary artery disease. Arch Intern Med 164(5):551–556. https://doi.org/10.1001/archinte.164.5.551

doi: 10.1001/archinte.164.5.551 pubmed: 15006833

Nathan SD, Basavaraj A, Reichner C, Shlobin OA, Ahmad S, Kiernan J et al (2010) Prevalence and impact of coronary artery disease in idiopathic pulmonary fibrosis. Respir Med 104(7):1035–1041. https://doi.org/10.1016/j.rmed.2010.02.008

doi: 10.1016/j.rmed.2010.02.008 pubmed: 20199856

André S, Conde B, Fragoso E, Boléo-Tomé JP, Areias V, Cardoso J (2019) COPD and cardiovascular disease. Pulmonology 25(3):168–176. https://doi.org/10.1016/j.pulmoe.2018.09.006

doi: 10.1016/j.pulmoe.2018.09.006 pubmed: 30527374

International guidelines for the selection of lung transplant candidates (1998) The american society for transplant physicians (ASTP)/American Thoracic Society(ATS)/European Respiratory Society(ERS)/International society for heart and lung transplantation(ISHLT). Am J Respir Crit Care Med 158(1):335–339. https://doi.org/10.1164/ajrccm.158.1.15812

doi: 10.1164/ajrccm.158.1.15812

Choong CK, Meyers BF, Guthrie TJ, Trulock EP, Patterson GA, Moazami N (2006) Does the presence of preoperative mild or moderate coronary artery disease affect the outcomes of lung transplantation? Ann Thorac Surg 82(3):1038–1042. https://doi.org/10.1016/j.athoracsur.2006.03.039

doi: 10.1016/j.athoracsur.2006.03.039 pubmed: 16928531

Zanotti G, Hartwig MG, Castleberry AW, Martin JT, Shaw LK, Williams JB et al (2014) Preoperative mild-to-moderate coronary artery disease does not affect long-term outcomes of lung transplantation. Transplantation 97(10):1079–1085. https://doi.org/10.1097/01.Tp.0000438619.96933.02

doi: 10.1097/01.Tp.0000438619.96933.02 pubmed: 24646771 pmcid: 4336175

Franz M, Siemeni T, Aburahma K, Yablonski P, Poyanmehr R, Avsar M et al (2022) Lung transplant and severe coronary artery disease: results from a single-centre experience. Eur J Cardiothorac Surg 62(2):ezac348. https://doi.org/10.1093/ejcts/ezac348

doi: 10.1093/ejcts/ezac348 pubmed: 35703921

Chaikriangkrai K, Jyothula S, Jhun HY, Estep J, Loebe M, Scheinin S et al (2016) Impact of pre-operative coronary artery disease on cardiovascular events following lung transplantation. J Heart Lung Transplant 35(1):115–121. https://doi.org/10.1016/j.healun.2015.08.009

doi: 10.1016/j.healun.2015.08.009 pubmed: 26452997

Sherman W, Rabkin DG, Ross D, Saggar R, Lynch JP 3rd, Belperio J et al (2011) Lung transplantation and coronary artery disease. Ann Thorac Surg 92(1):303–308. https://doi.org/10.1016/j.athoracsur.2011.04.021

doi: 10.1016/j.athoracsur.2011.04.021 pubmed: 21718862

Khandhar SJ, Althouse AD, Mulukutla S, Kormos R, Toma C, Marroquin O et al (2017) Postoperative outcomes and management strategies for coronary artery disease in patients in need of a lung transplantation. Clin Transplant 31(9):e13026. https://doi.org/10.1111/ctr.13026

doi: 10.1111/ctr.13026

Koprivanac M, Budev MM, Yun JJ, Kelava M, Pettersson GB, McCurry KR et al (2016) How important is coronary artery disease when considering lung transplant candidates? J Heart Lung Transplant 35(12):1453–1461. https://doi.org/10.1016/j.healun.2016.03.011

doi: 10.1016/j.healun.2016.03.011 pubmed: 27266805

McKellar SH, Bowen ME, Baird BC, Raman S, Cahill BC, Selzman CH (2016) Lung transplantation following coronary artery bypass surgery-improved outcomes following single-lung transplant. J Heart Lung Transplant 35(11):1289–1294. https://doi.org/10.1016/j.healun.2016.05.029

doi: 10.1016/j.healun.2016.05.029 pubmed: 27381675

Halloran K, Hirji A, Li D, Jackson K, Kapasi A, Meyer S et al (2019) Coronary artery disease and coronary artery bypass grafting at the time of lung transplantation do not impact overall survival. Transplantation 103(10):2190–2195. https://doi.org/10.1097/tp.0000000000002609

doi: 10.1097/tp.0000000000002609 pubmed: 30801514

Leard LE, Holm AM, Valapour M, Glanville AR, Attawar S, Aversa M et al (2021) Consensus document for the selection of lung transplant candidates: an update from the international society for heart and lung transplantation. J Heart Lung Transplant 40(11):1349–1379. https://doi.org/10.1016/j.healun.2021.07.005

doi: 10.1016/j.healun.2021.07.005 pubmed: 34419372 pmcid: 8979471

Allen JG, Arnaoutakis GJ, Weiss ES, Merlo CA, Conte JV, Shah AS (2010) The impact of recipient body mass index on survival after lung transplantation. J Heart Lung Transplant 29(9):1026–1033. https://doi.org/10.1016/j.healun.2010.05.005

doi: 10.1016/j.healun.2010.05.005 pubmed: 20558085

Ehrsam JP, Benden C, Seifert B, Opitz I, Schneiter D, Weder W et al (2017) Lung transplantation in the elderly: Influence of age, comorbidities, underlying disease, and extended criteria donor lungs. J Thorac Cardiovasc Surg 154(6):2135–2141. https://doi.org/10.1016/j.jtcvs.2017.07.032

doi: 10.1016/j.jtcvs.2017.07.032 pubmed: 28823801

Schaffer JM, Singh SK, Reitz BA, Zamanian RT, Mallidi HR (2015) Single- vs double-lung transplantation in patients with chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis since the implementation of lung allocation based on medical need. JAMA 313(9):936–948. https://doi.org/10.1001/jama.2015.1175

doi: 10.1001/jama.2015.1175 pubmed: 25734735

Loor G, Brown R, Kelly RF, Rudser KD, Shumway SJ, Cich I et al (2017) Gender differences in long-term survival post-transplant: A single-institution analysis in the lung allocation score era. Clin Transplant. 31(3):e12889. https://doi.org/10.1111/ctr.12889

doi: 10.1111/ctr.12889

Klomjit N, Mehrnia A, Sampaio M, Bunnapradist S (2015) Impact of diabetes mellitus on survival outcome of lung transplant recipients: an analysis of OPTN/UNOS data. Clin Transpl 31:43–55

pubmed: 28514567

Adamson PD, Anderson JA, Brook RD, Calverley PMA, Celli BR, Cowans NJ, Crim C, Dixon IJ, Martinez FJ, Newby DE, Vestbo J, Yates JC, Mills NL (2018) Cardiac troponin i and cardiovascular risk in patients with chronic obstructive pulmonary disease. J Am Coll Cardiol 72(10):1126–1137. https://doi.org/10.1016/j.jacc.2018.06.051

doi: 10.1016/j.jacc.2018.06.051 pubmed: 30165984 pmcid: 6119211

Kilic A, Merlo CA, Conte JV, Shah AS (2012) Lung transplantation in patients 70 years old or older: have outcomes changed after implementation of the lung allocation score? J Thorac Cardiovasc Surg 144(5):1133–1138. https://doi.org/10.1016/j.jtcvs.2012.07.080

doi: 10.1016/j.jtcvs.2012.07.080 pubmed: 22944081

Schiopu SRI, Zacherl M, Todica A, Bartenstein P, Milger K, Leuschner G, Munker D, Bauer M, Massberg S, Behr J, Neurohr C, Huber BC, Kneidinger N (2020) Feasibility and accuracy of SPECT myocardial perfusion imaging in end-stage lung disease. J Nucl Cardiol 27(3):903–911. https://doi.org/10.1007/s12350-019-01851-4

doi: 10.1007/s12350-019-01851-4 pubmed: 31428982

Wild J, Arrigo M, Isenring BD, Buergi U, Kurowski T, Schuurmans MM, Huber LC, Benden C (2015) Coronary artery disease in lung transplant candidates: role of routine invasive assessment. Respiration 89(2):107–111. https://doi.org/10.1159/000368368

doi: 10.1159/000368368 pubmed: 25592298

Castleberry AW, Martin JT, Osho AA, Hartwig MG, Hashmi ZA, Zanotti G, Shaw LK, Williams JB, Lin SS, Davis RD (2013) Coronary revascularization in lung transplant recipients with concomitant coronary artery disease. Am J Transplant 13(11):2978–2988. https://doi.org/10.1111/ajt.12435

doi: 10.1111/ajt.12435 pubmed: 24102830 pmcid: 4332513

Kanaparthi J, Kashem MA, Suryapalam M, Zhao H, Brann S, Leotta E, Minakata K, Keshavamurthy S, Shigemura N, Toyoda Y (2020) Prior and perioperative revascularization does not affect survival in lung transplant patients. Ann Thorac Surg 109(6):1677–1683. https://doi.org/10.1016/j.athoracsur.2020.01.016

doi: 10.1016/j.athoracsur.2020.01.016 pubmed: 32105715

Makey IA, Sui JW, Huynh C, Das NA, Thomas M, Johnson S (2018) Lung transplant patients with coronary artery disease rarely die of cardiac causes. Clin Transplant. 32(9):e13354. https://doi.org/10.1111/ctr.13354

doi: 10.1111/ctr.13354 pubmed: 30022532

Yang K, Zhang M, Zhang B, Zhang Y, Zhao Q (2022) Systematic review and meta-analysis of calcineurin inhibitors on long-term prognosis of renal transplant patients. Transpl Immunol 75:101741. https://doi.org/10.1016/j.trim.2022.101741

doi: 10.1016/j.trim.2022.101741 pubmed: 36372141

Perch M, Hayes D Jr, Cherikh WS, Zuckermann A, Harhay MO, Hsich E, Potena L, Sadavarte A, Lindblad K, Singh TP, Stehlik J, International Society for Heart and Lung Transplantation (2022) The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-ninth adult lung transplantation report-2022; focus on lung transplant recipients with chronic obstructive pulmonary disease. J Heart Lung Transplant 41(10):1335–1347. https://doi.org/10.1016/j.healun.2022.08.007

doi: 10.1016/j.healun.2022.08.007 pubmed: 36050206 pmcid: 10257980

Salman J, Ius F, Sommer W, Siemeni T, Kuehn C, Avsar M, Boethig D, Molitoris U, Bara C, Gottlieb J, Welte T, Haverich A, Hoeper MM, Warnecke G, Tudorache I (2017) Mid-term results of bilateral lung transplant with postoperatively extended intraoperative extracorporeal membrane oxygenation for severe pulmonary hypertension. Eur J Cardiothorac Surg 52(1):163–170. https://doi.org/10.1093/ejcts/ezx047

doi: 10.1093/ejcts/ezx047 pubmed: 28329232

Schwarz S, Lang C, Harlander M, Štupnik T, Slambrouck JV, Ceulemans LJ, Ius F, Gottlieb J, Kuhnert S, Hecker M, Aigner C, Kneidinger N, Verschuuren EA, Smits JM, Tschernko E, Schaden E, Faybik P, Markstaller K, Trauner M, Jaksch P, Hoetzenecker K (2022) Gamma-glutamyltransferase is a strong predictor of secondary sclerosing cholangitis after lung transplantation for COVID-19 ARDS. J Heart Lung Transplant 41(10):1501–1510. https://doi.org/10.1016/j.healun.2022.06.020

doi: 10.1016/j.healun.2022.06.020 pubmed: 35907758 pmcid: 9249665

Yang Z, Subramanian MP, Yan Y, Meyers BF, Kozower BD, Patterson GA, Nava RG, Hachem RR, Witt CA, Pasque MK, Byers DE, Kulkarni HS, Kreisel D, Itoh A, Puri V (2022) The impact of center volume on outcomes in lung transplantation. Ann Thorac Surg 113(3):911–917. https://doi.org/10.1016/j.athoracsur.2021.03.092

doi: 10.1016/j.athoracsur.2021.03.092 pubmed: 33857492