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Lung transplantation following coronary artery bypass surgery—improved outcomes following single-lung transplant
Open accessAbstract
Background Prior coronary artery bypass grafting (CABG) has been a contraindication to lung transplantation (LTx) because of disease severity and technical considerations. Although patients increasingly are being referred for and receiving LTx, whether it should remain a contraindication is unknown. We sought to define the prevalence of LTx after CABG and determine the effect on outcomes.Methods The United Network for Organ Sharing Standard Transplant Analysis and Research data set was queried during the period 2004-2013 for adult LTx patients, as prior CABG became a mandatory reporting field in 2004. The primary end-points were 30-day and 1-, 3-, and 5-year survivals.Results The study cohort included 14,791 patients, of whom 292 patients had previously undergone CABG (single left, n = 68; single right, n = 181; bilateral, n = 43), representing 2% of all transplants. For the entire cohort, 30-day survival was 97%, and survival at 1, 3, and 5 years was 88%, 79%, and 74%. CABG was a predictor of mortality at all time points, with hazard ratios ranging from 1.97 (confidence interval, 1.23-3.16; p < 0.01) at 30 days to 1.38 (confidence interval, 1.12-1.69; p < 0.01) at 5 years. When stratified by type of transplant, CABG strongly predicted mortality at all time points for patients receiving bilateral, but not single, transplants.Conclusions Although LTx after CABG is uncommon, it is increasingly performed in the current era. Single right LTx is the most common procedure performed in patients with prior CABG. CABG before LTx is an independent predictor of mortality at all time points and is driven by increased mortality in patients receiving bilateral LTx.
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In patients with prior CABG, bilateral lung transplant has been associated with inferior survival compared to single lung transplant.
“In those patients with a history of prior CABG, bilateral lung transplant has been associated with inferior survival compared to those who undergo single lung transplant.(28)”
From Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. (2021) · cites this paper as [28]
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Metadata
- Authors
- McKellar, S. H., Bowen, M. E., Baird, B. C., Raman, S., Cahill, B. C., & Selzman, C. H.
- Affiliations
- University of Utah (US)
- Arizona Western College (US)
- Corresponding author
- McKellar, Stephen H.
- Venue
- The Journal of Heart and Lung Transplantation
- Publisher
- Elsevier BV
- Published
- 2016-11
- Volume
- 35
- Issue
- 11
- Pages
- 1289-1294
- ISSN
- 1053-2498 (ISSN-L)
- OpenAlex
- W2419859212
- Semantic Scholar
- 4517062e0f5e4be272282231f48887d79347d2cb
- Cited by
- 31
- References
- 12
- Citations by year
- 2025: 2 · 2024: 6 · 2023: 3 · 2022: 5 · 2021: 5 · 2020: 3 · 2019: 1 · 2018: 2 · 2017: 3 · 2016: 1
- FWCI
- 2.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Heart and Lung Transplantation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- School of Medicine
- Topics
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Organ Donation and Transplantation
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Keywords
- lung transplantation, coronary artery bypass grafting, single lung transplantation, bilateral lung transplantation, transplant outcomes, mortality
- MeSH terms
- Coronary Artery Bypass, Coronary Artery Disease, Follow-Up Studies, Humans, Lung Diseases, Reoperation, Lung Transplantation, Treatment Outcome, Practice Guidelines as Topic
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