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The effect of prior pneumonectomy or lobectomy on subsequent lung transplantation.

Publication ,  Journal Article
Ganapathi, AM; Speicher, PJ; Castleberry, AW; Englum, BR; Osho, AA; Davis, RD; Hartwig, MG
Published in: Ann Thorac Surg
December 2014

BACKGROUND: Lung transplantation in patients with prior lobectomy or pneumonectomy is not well understood. Using the United Network for Organ Sharing (UNOS) database, we address the impact of prior major lung resection on lung transplantation outcomes. METHODS: Retrospective review of adult lung transplants from October 1999 to December 2011 in the UNOS database identified 15,300 lung transplants; 102 patients had undergone major lung resection, defined as prior pneumonectomy (n = 22) or lobectomy (n = 80). Propensity match with nonparametric 3:1 nearest-neighbor matching algorithm adjusted for treatment-level differences. After matching, the primary outcome (90-day mortality) and secondary outcome (airway dehiscence, need for dialysis, length of stay more than 25 days) were assessed with univariable and multivariable methods. Subanalysis of pneumonectomy and lobectomy individually compared with matched nonresection patients was done in a similar manner. The Kaplan-Meier method estimated long-term survival. RESULTS: After matching, no significant differences were noted between groups for recipient, donor, or operative characteristics. There were 10 double lung and 12 single lung transplants after pneumonectomy and 51 double lung and 29 single lung transplants after lobectomy. Mortality at 90 days was 13.9% (n = 14) for the resection group and 8.6% (n = 1,247) for the nonresection group (p = 0.09). After matching, a significant increase was noted in 90-day mortality (p = 0.017) and perioperative dialysis (p = 0.039) for the resection versus nonresection patients. Dialysis was significantly higher among pneumonectomy patients (p = 0.03). No long-term survival difference was observed (p = 0.514). CONCLUSIONS: After propensity-matching, resection was associated with increased 90-day mortality and dialysis. Careful patient selection is necessary with patients who have undergone prior major lung resection, given their increased risk of perioperative mortality and dialysis.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

December 2014

Volume

98

Issue

6

Start / End Page

1922 / 1928

Location

Netherlands

Related Subject Headings

  • Tissue Donors
  • Time Factors
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Respiratory System
  • Postoperative Complications
  • Pneumonectomy
  • Patient Selection
 

Citation

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Ganapathi, A. M., Speicher, P. J., Castleberry, A. W., Englum, B. R., Osho, A. A., Davis, R. D., & Hartwig, M. G. (2014). The effect of prior pneumonectomy or lobectomy on subsequent lung transplantation. Ann Thorac Surg, 98(6), 1922–1928. https://doi.org/10.1016/j.athoracsur.2014.06.042
Ganapathi, Asvin M., Paul J. Speicher, Anthony W. Castleberry, Brian R. Englum, Asishana A. Osho, R Duane Davis, and Matthew G. Hartwig. “The effect of prior pneumonectomy or lobectomy on subsequent lung transplantation.Ann Thorac Surg 98, no. 6 (December 2014): 1922–28. https://doi.org/10.1016/j.athoracsur.2014.06.042.
Ganapathi AM, Speicher PJ, Castleberry AW, Englum BR, Osho AA, Davis RD, et al. The effect of prior pneumonectomy or lobectomy on subsequent lung transplantation. Ann Thorac Surg. 2014 Dec;98(6):1922–8.
Ganapathi, Asvin M., et al. “The effect of prior pneumonectomy or lobectomy on subsequent lung transplantation.Ann Thorac Surg, vol. 98, no. 6, Dec. 2014, pp. 1922–28. Pubmed, doi:10.1016/j.athoracsur.2014.06.042.
Ganapathi AM, Speicher PJ, Castleberry AW, Englum BR, Osho AA, Davis RD, Hartwig MG. The effect of prior pneumonectomy or lobectomy on subsequent lung transplantation. Ann Thorac Surg. 2014 Dec;98(6):1922–1928.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

December 2014

Volume

98

Issue

6

Start / End Page

1922 / 1928

Location

Netherlands

Related Subject Headings

  • Tissue Donors
  • Time Factors
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Respiratory System
  • Postoperative Complications
  • Pneumonectomy
  • Patient Selection