Research Article

Long-Term Impact of Coronary Artery Disease in Lung Transplantation

William S Ragalie, Nilto C de Oliveira, Richard Cornwell, Keith Meyer and James D Maloney*

Published: 26 November, 2019 | Volume 4 - Issue 3 | Pages: 227-232

Background: Adoption of the Lung Allocation Score (LAS) has led to increased listing of older patients and those with idiopathic pulmonary fibrosis (IPF) for lung transplantation (LTX). Older patients and those with IPF have higher prevalence of coronary artery disease (CAD), a relative contraindication for LTX. The impact of the LAS on CAD prevalence and cardiovascular morbidity in LTX recipients is unknown.

Methods: Retrospective review of single institution database from January 2000 to December 2010. Patients with and without CAD were compared by age, gender, LAS, single vs double LTX, and transplant indication. Survival was calculated by Kaplan-Meier method, and statistical significance determined by log-rank method. Survival analysis was performed on all patients and by 3:1 propensity matching. Differences in CAD, gender, and indication were determined by Chi-squared test. Differences in LAS and age were calculated with a two-tailed t - test.

Results: In the pre-LAS era, 6.2% (9/145) recipients had CAD vs. 9.2% (17/184) in the post-LAS era (p = 0.411). Among all patients, recipients with CAD had a worse long term survival as estimated by Kaplan-Meier method (p = 0.001), although there was no statistically significant difference after propensity matching ((p = 0.14). Although more recipients in the post-LAS era had a diagnosis of IPF [15/145 vs. 71/184 patients, (p < 0.001)], there was no difference in the prevalence of CAD in the IPF cohort compared to others. There were no differences in cardiovascular deaths among recipients with CAD, with IPF, or in the post-LAS era. Patients with a pre-transplant diagnosis of CAD had an descreased risk of new onset postoperative atrial fibrillation (AF) (p = 0.007; HR:0.133; CI:0.030-0.583).

Conclusion: Adoption of the LAS was not associated with a significant change in proportion of recipients with CAD who underwent LTX at our institution, despite an increase in recipients with IPF. Recipients with CAD had a higher risk of developing new postoperative AF and worse survival than patients without CAD. Differences in survival, however, could not be attributed directly to CAD based on propensity matched analysis

Read Full Article HTML DOI: 10.29328/journal.jccm.1001073 Cite this Article Read Full Article PDF


Adult; Lung transplantation; Atherosclerosis; Coronary artery disease; Lung allocation; Follow-up studies; Survival rate; Coronary disease in transplant


  1. Rana A, Gruessner A, Agopian VG, Khalpey Z, Riaz IB, et al. Srvival benefit of solid-organ transplant in the united states. JAMA Surg. 2015; 150: 252-259. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25629390
  2. Punch JD, Hayes DH, LaPorte FB, McBride V, Seely MS. Organ donation and utilization in the United States, 1996-2005. Am J Transplant. 2007; 7: 1327-1338. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17428283
  3. Mascia L, Pasero D, Slutsky AS, Arguis MJ, Berardino M, et al. Effect of a lung protective strategy for organ donors on eligibility and availability of lungs for transplantation: a randomized controlled trial. JAMA. 2010; 304: 2620-2627. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21156950
  4. Leibowitz DW, Caputo AL, Shapiro GC, Schulman LL, McGregor CC, et al. Coronary angiography in smokers undergoing evaluation for lung transplantation: is routine use justified? J Heart Lung Transplant. 1994; 13: 701-703. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/7947888
  5. Manoushagian S, Meshkov A. Evaluation of solid organ transplant candidates for coronary artery disease. Am J Transplant. 2014; 14: 2228-2234. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25220486
  6. Jones RM, Enfield KB, Mehrad B, Keeley EC. Prevalence of obstructive coronary artery disease in patients undergoing lung transplantation: case series and review of the literature. Catheter Cardiovasc Interv. 2014; 84: 1-6. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24136925
  7. Choong CK, Meyers BF, Guthrie TJ, Trulock EP, Patterson GA, et al. Does the presence of preoperative mild or moderate coronary artery disease affect the outcomes of lung transplantation? Ann Thorac Surg. 2006; 82: 1038-1042. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16928531
  8. Lee R, Meyers BF, Sundt TM, Trulock EP, Patterson GA. Concomitant coronary artery revascularization to allow successful lung transplantation in selected patients with coronary artery disease. J Thorac Cardiovasc Surg. 2002; 124: 1250-1251. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12447202
  9. Sherman W, Rabkin DG, Ross D, Saggar R, Lynch JP 3rd, et al. Lung transplantation and coronary artery disease. Ann Thorac Surg. 2011; 92: 303-308. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21718862
  10. Dalleywater W, Powell HA, Hubbard RB, Navaratnam V. Risk factors for cardiovascular disease in people with idiopathic pulmonary fibrosis: a population-based study. Chest. 2015; 147: 150-156. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25121965
  11. Izbicki G, Ben-Dor I, Shitrit D, Bendayan D, Aldrich TK, et al. The prevalence of coronary artery disease in end-stage pulmonary disease: is pulmonary fibrosis a risk factor? Respir Med. 2009; 103: 1346-1349. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19362458
  12. Nathan SD, Basavaraj A, Reichner C, Shlobin OA, Ahmad S, et al. Prevalence and impact of coronary artery disease in idiopathic pulmonary fibrosis. Respir Med. 2010; 104: 1035-1041. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20199856
  13. Burlingham WJ, Love RB, Jankowska-Gan E, Haynes LD, Xu Q, et al. IL-17-dependent cellular immunity to collagen type V predisposes to obliterative bronchiolitis in human lung transplants. J Clin Invest. 2007; 117: 3498-3506. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17965778
  14. Park AC, Huang G, Jankowska-Gan E, Massoudi D, Kernien JF, et al. Mucosal administration of collagen V ameliorates atherosclerotic plaque burden by inducing IL-35-dependent tolerance. J Biol Chem. 2015. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26721885
  15. Francois A, Gombault A, Villeret B, Alsaleh G, Fanny M, et al. B cell activating factor is central to bleomycin- and IL-17-mediated experimental pulmonary fibrosis. J Autoimmun. 2015; 56: 1-11. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25441030
  16. Wilkes DS, Chew T, Flaherty KR, Frye S, Gibson KF, Kaminski N, et al. Oral immunotherapy with type V collagen in idiopathic pulmonary fibrosis. Eur Respir J. 2015; 45: 1393-1402. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25614165
  17. Kistler KD, Nalysnyk L, Rotella P, Esser D. Lung transplantation in idiopathic pulmonary fibrosis: a systematic review of the literature. BMC Pulm Med. 2014; 14: 139. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25127540
  18. Osaki S, Maloney JD, Meyer KC, Cornwell RD, Edwards NM, et al. The impact of the lung allocation scoring system at the single national Veterans Affairs Hospital lung transplantation program. Eur J Cardiothorac Surg. 2009; 36: 497-501. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19394854
  19. Merlo CA, Weiss ES, Orens JB, Borja MC, Diener-West M, et al. Impact of U.S. Lung Allocation Score on survival after lung transplantation. J Heart Lung Transplant. 2009; 28: 769-775. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19632571
  20. Yusen RD, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, et al. The registry of the International Society for Heart and Lung Transplantation: thirty-first adult lung and heart-lung transplant report-2014; focus theme: retransplantation. J Heart Lung Transplant. 2014; 33: 1009-1024. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25242124
  21. Seoane L, Arcement LM, Valentine VG, McFadden PM. Long-term survival in lung transplant recipients after successful preoperative coronary revascularization. J Thorac Cardiovasc Surg. 2005; 130: 538-541. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16077424
  22. Patel VS, Palmer SM, Messier RH, Davis RD. Clinical outcome after coronary artery revascularization and lung transplantation. Ann Thorac Surg. 2003; 75: 372-377. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12607642
  23. Patel VS, Messier RH, Palmer SM, Davis RD. Coronary artery revascularization in eligible lung transplant recipients. J Heart Lung Transplant. 2001; 20: 223. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11250417
  24. Zanotti G, Hartwig MG, Castleberry AW, Martin JT, Shaw LK, et al. Preoperative mild-to-moderate coronary artery disease does not affect long-term outcomes of lung transplantation. Transplantation. 2014; 97: 1079-1085. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24646771
  25. Castleberry AW, Martin JT, Osho AA, Hartwig MG, Hashmi ZA, et al. Coronary revascularization in lung transplant recipients with concomitant coronary artery disease. Am J Transplant. 2013; 13: 2978-2988. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24102830
  26. Hertz MI, Aurora P, Benden C, Christie JD, Dobbels F, et al. Scientific Registry of the International Society for Heart and Lung Transplantation: introduction to the 2011 annual reports. J Heart Lung Transplant. 2011; 30: 1071-1077. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21962015
  27. Julliard WA, Meyer KC, De Oliveira NC, Osaki S, Cornwell RC, et al. The presence or severity of pulmonary hypertension does not affect outcomes for single-lung transplantation. Thorax. 2015. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26621135


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