Lung Volume Reduction Surgery Prior to Lung Transplantation: A Propensity-Matched Analysis.

BACKGROUND: Lung volume reduction surgery (LVRS) is treatment for chronic obstructive pulmonary disease (COPD), the second most common indication for lung transplantation (LTx) in the US. LVRS prior to LTx is controversial. Single institution studies report contradicting results, and the impact of undergoing LVRS prior to LTx on outcomes after LTx is unclear.

METHODS: We reviewed the United Network for Organ Sharing database for all adults (age>18) who underwent first-time LTx for COPD in the Lung Allocation Score era. We used patient demographic and clinical characteristics, and LAS to propensity match patients who did and did not undergo LVRS prior to LTx. The primary exposure was prior LVRS. The primary outcome was graft failure after LTx. Unadjusted Kaplan Meier and Adjusted Cox proportional hazards modeling were used to assess outcomes.

RESULTS: A total of 4,905 patients with COPD underwent LTx between May 2005 and March 2017. Of them, 107 patients (2.2%) underwent LVRS prior to LTx. Propensity matching generated 212 matches (106 LVRS+LTx, and 106 LTx-only). Median survival was significantly longer in the LTx-only cohort (6.5 years versus 3.4 years, p=0.034). LVRS prior to lung transplantation was associated with significantly increased risk of graft failure after lung transplant (HR:1.72, 95% CI: 1.13-2.60, p=0.01).

CONCLUSIONS: In this national, propensity matched analysis of LVRS prior to LTx, we show that LVRS is associated with a significantly increased risk of graft failure. Patients who undergo LVRS and remain in need of LTx should be carefully assessed and followed post-operatively.