title: Lung transplantation in patients who have undergone prior cardiothoracic procedures.
abstract: Patients who have undergone prior cardiothoracic procedures offer technical challenges that may affect post-transplant outcomes and be a reason to decline listing. Data are currently limited regarding the indication for lung transplantation among recipients who have had prior cardiothoracic procedures.
  
  
  
  Of 453 lung transplants performed at Cleveland Clinic from January 2005 to July 2010, 206 recipients (45%) had undergone prior cardiothoracic procedures: 157 lung only, 15 cardiac only, 10 cardiac + lung, 10 pleurodesis + lung, and 14 other. Chest tube placement was performed in 202 patients. Survival, post-transplant length of intensive care unit and hospital stays, primary graft dysfunction, and pulmonary function outcomes were compared with outcomes of patients not having prior procedures using propensity score adjustment.
  
  
  
  Short-term and long-term survival was similar between the 2 groups. Survival at 30 days, 1 year, and 5 years was 94%, 83%, and 55% for the prior cardiothoracic procedure group and 96%, 84%, and 53% for the no prior cardiothoracic procedure group (log-rank p = 0.9). Intensive care unit stay was longer (6 days vs 5 days, p = 0.02) in the prior cardiothoracic procedure group; this was particularly true for pleurodesis + lung (10 days, p = 0.05), although post-transplant hospital stay was similar (16 days, 16 days, and 22 days; p = 0.13). Primary graft dysfunction was not increased in the prior cardiothoracic procedure group. Forced expiratory volume in 1 second was similar for both groups but lower for thoracotomy and lung procedures using a bilateral chest tube (p < 0.05 each).
  
  
  
  A prior cardiothoracic procedure is not a contraindication for lung transplantation.
authors: Department of Thoracic and Cardiovascular Surgery, Research Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Mohamed
authors: M
authors: Omara
authors: Department of Thoracic and Cardiovascular Surgery, Research Institute, Cleveland Clinic, Cleveland, Ohio; Transplant Center, Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Pathobiology, Lerner Research Center, Cleveland Clinic, Cleveland, Ohio.
authors: Toshihiro
authors: T
authors: Okamoto
authors: Department of Thoracic and Cardiovascular Surgery, Research Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Amr
authors: A
authors: Arafat
authors: Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Lucy
authors: L
authors: Thuita
authors: Department of Thoracic and Cardiovascular Surgery, Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Eugene H
authors: EH
authors: Blackstone
authors: Department of Thoracic and Cardiovascular Surgery, Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Pathobiology, Lerner Research Center, Cleveland Clinic, Cleveland, Ohio. Electronic address: mccurrk@ccf.org.
authors: Kenneth R
authors: KR
authors: McCurry
mesh_terms: D006801:Humans; D007902:Length of Stay; D008168:Lung; D008171:Lung Diseases; D016040:Lung Transplantation; D055031:Primary Graft Dysfunction; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: cardiac surgery; cardiothoracic procedure; chest tube; lung transplantation; pleurodesis