How important is coronary artery disease when considering lung transplant candidates?
Coronary artery disease (CAD) remains a relative contraindication for lung transplantation, but should it be if amenable to effective palliation?



From January 2005 to July 2010, 356 adults undergoing primary lung transplantation had no significant (<50%) coronary arterial stenosis and 70 had significant (≥50%) CAD requiring prior or concomitant revascularization. Propensity matching on 38 pre-transplant patient characteristics identified 61 well-matched pairs (87% of possible matches) and 295 no-CAD unmatched patients to compare post-operative morbidity, graft function, and time-related pulmonary function and survival.



Compared with no-CAD patients, those with CAD intervention were older, more likely to be male, had more comorbidities, and were more likely to have idiopathic pulmonary fibrosis. Among propensity-matched patients, 5 died in-hospital in the CAD intervention group and 6 in the no-CAD group (p = 0.7). Intensive care unit stay (5 vs 7 days), post-operative stay (14 vs 15 days), tracheostomy requirement (12 vs 11 patients), primary graft dysfunction scores (p >0.8), and early longitudinal post-transplant pulmonary function (p = 0.2) were similar, as was time-related mortality (20% vs 22% and 51% vs 52% at 1 and 4 years, respectively; p = 0.6). Unmatched no-CAD patients had fewer comorbidities and lower mortality than matched patients (15% and 39% at 1 and 4 years, respectively; p = 0.01).



CAD is an important risk factor in lung transplant candidates, but its influence can be minimized in experienced centers by effective palliation. Surprisingly, however, CAD is a marker for an unfavorable patient phenotype with worse than typical post-transplant survival, irrespective of whether CAD is present.
Thoracic and Cardiovascular Surgery.
Marijan
M
Koprivanac
Cardiovascular Medicine, Heart and Vascular Institute.
Marie M
MM
Budev
Thoracic and Cardiovascular Surgery.
James J
JJ
Yun
Thoracic and Cardiovascular Surgery.
Marta
M
Kelava
Thoracic and Cardiovascular Surgery.
Gösta B
GB
Pettersson
Thoracic and Cardiovascular Surgery.
Kenneth R
KR
McCurry
Thoracic and Cardiovascular Surgery.
Douglas R
DR
Johnston
Thoracic and Cardiovascular Surgery.
Abeel A
AA
Mangi
Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
Penny L
PL
Houghtaling
Thoracic and Cardiovascular Surgery; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
Eugene H
EH
Blackstone
Thoracic and Cardiovascular Surgery. Electronic address: murthys1@ccf.org.
Sudish C
SC
Murthy
D003324:Coronary Artery Disease; D006085:Graft Survival; D006801:Humans; D008171:Lung Diseases; D016040:Lung Transplantation; D008297:Male; D012307:Risk Factors
cardiac revascularization; coronary artery disease; graft function; lung transplantation; morbidity; survival