Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Lüsebrink, E; Gade, N; Seifert, P; Ceelen, F; Veit, T; Fohrer, F; Hoffmann, S; Höpler, J; Binzenhöfer, L; Roden, D; Saleh, I; Lanz, H; Michel, S; Schneider, C; Irlbeck, M; Tomasi, R; Hatz, R; Hausleiter, J; Hagl, C; Magnussen, C; Meder, B; Zimmer, S; Luedike, P; Schäfer, A; Orban, M; Milger, K; Behr, J; Massberg, S; Kneidinger, N.
The role of coronary artery disease in lung transplantation: a propensity-matched analysis.
Clin Res Cardiol. 2024; 113(12):1717-1732
Doi: 10.1007/s00392-024-02445-y
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- Führende Autor*innen der Med Uni Graz
- Kneidinger Nikolaus
- Co-Autor*innen der Med Uni Graz
- Milger-Kneidinger Katrin
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- Abstract:
- BACKGROUND AND AIMS: 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. 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: 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: 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.
- Find related publications in this database (using NLM MeSH Indexing)
- Humans - administration & dosage
- Coronary Artery Disease - surgery, mortality
- Male - administration & dosage
- Female - administration & dosage
- Lung Transplantation - administration & dosage
- Retrospective Studies - administration & dosage
- Propensity Score - administration & dosage
- Middle Aged - administration & dosage
- Risk Factors - administration & dosage
- Adult - administration & dosage
- Hospital Mortality - trends
- Postoperative Complications - epidemiology
- Survival Rate - trends
- Follow-Up Studies - administration & dosage
- Risk Assessment - methods
- Time Factors - administration & dosage
- Find related publications in this database (Keywords)
- Lung transplantation
- Coronary artery disease
- Transplant candidate selection
- Cardiovascular evaluation
- Extracorporeal membrane oxygenation
- Revascularization