Coronary artery disease is common in lung transplant patients and has historically been viewed as a contraindication to the procedure. Although this mindset is changing, the effect of prior or peri-operative revascularization on lung transplant survival outcomes is not adequately established.
We performed a single-center retrospective analysis of all single and double lung transplant patients from 2012-2018 (n=468). Patients were split into four groups: 1) patients that received a pre-operative PCI (n=34), 2) patients that received coronary artery bypass grafting prior to transplantation (n=25), 3) patients that received concomitant coronary artery bypass grafting during transplantation (n=29), and 4) patients that had lung transplantation with no need for revascularization (n=380). Groups were compared for demographics, surgical procedure, and survival outcomes.
The no revascularization group was statistically younger than the rest (p=0.001). The lung allocation score trended towards being higher in the concomitant coronary artery byspass (p=0.03). All groups were predominantly diagnosed with IPF. The proportion of patients with COPD was greatest in the group not requiring revascularization (p=0.001). Patients with previous coronary artery bypass grafting were more likely to receive a single lung transplant than a double (21 vs 4, P=0.054). Length of stay, post-transplant survival, and postoperative adverse events were similar amongst all groups.
Results suggest preoperative or intraoperative revascularization does not negatively impact survival in lung transplant patients; lung recipients with coronary artery disease have comparable survival when adequately revascularized.

Copyright © 2020. Published by Elsevier Inc.