title: Outcomes in lung transplantation after previous lung volume reduction surgery in a contemporary cohort.
abstract: OBJECTIVE
  Lung volume reduction surgery (LVRS) provides palliation and improved quality of life in select patients with end-stage chronic obstructive pulmonary disease (COPD). The effect of previous LVRS on lung transplant outcomes has been inadequately studied. We report our experience in the largest single institution series of these combined procedures.
  
  
  METHODS
  The records of 472 patients with COPD undergoing lung transplantation or LVRS between 1995 and 2010 were reviewed. Outcomes of patients undergoing transplant after LVRS were compared with outcomes of patients undergoing transplant or LVRS alone. Survival was compared using log-rank tests and the Kaplan-Meier method.
  
  
  RESULTS
  Demographics, comorbidities, and spirometry were similar at the time of transplantation. Patients who had undergone lung transplant after LVRS had longer transplant operative times (mean 4.4 vs 5.6 hours; P = .020) and greater hospital length of stay (mean 17.6 vs 29.1 days; P = .005). Thirty-day mortality and major morbidity were similar. Posttransplant survival was reduced for transplant after LVRS (median, 49 months; 95% confidence interval [CI], 16, 85 months) compared with transplant alone (median, 96 months; 95% CI, 82, 106 months; P = .008). The composite benefit of combined procedures, defined as bridge from LVRS to transplant of 55 months and posttransplant survival of 49 months (total 104 months), was comparable with survival of patients undergoing either procedure alone.
  
  
  CONCLUSIONS
  Lung transplant after LVRS leads to minimal additional perioperative risk. The reduced posttransplant survival in patients undergoing combined procedures is in contradistinction to reports from other smaller series. When determining the best surgical treatment for patients with more severe disease, the benefit of LVRS before transplant should be weighed against the consequence of reduced posttransplant survival.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Wash. Electronic address: lbackhus@u.washington.edu.
authors.forename: Leah
authors.initials: L
authors.lastname: Backhus
authors.affiliation: University of Washington School of Medicine, Seattle, Wash.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Sargent
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Wash.
authors.forename: Aaron
authors.initials: A
authors.lastname: Cheng
authors.affiliation: Department of Health Services, University of Washington School of Public Health, Seattle, Wash.
authors.forename: Steven
authors.initials: S
authors.lastname: Zeliadt
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Wash.
authors.forename: Douglas
authors.initials: D
authors.lastname: Wood
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Wash.
authors.forename: Michael
authors.initials: M
authors.lastname: Mulligan
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008168:Lung / Q000503:physiopathology / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects / Q000401:mortality; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014861:Washington