Lung transplantation in patients with a history of anatomical native lung resection

Abstract

OBJECTIVES History of anatomical lung resection complicates lung transplantation (LTx). Our aim was to identify indications, intraoperative approach, and outcome in these challenging cases in a retrospective multicentre cohort analysis. METHODS Members of the ESTS Lung Transplantation Working Group were invited to submit data on patients undergoing LTx after a previous anatomical native lung resection between 01/2005 and 07/2020. The primary end-point was overall survival (Kaplan–Meier estimation). RESULTS Out of 2690 patients at 7 European centers, 26 (1%) patients (14 male; median age 33 years) underwent LTx after a previous anatomical lung resection. Median time from previous lung resection to LTx was 12 years. The most common indications for lung resection were infections (n = 17), emphysema (n = 5), lung tumour (n = 2), and others (n = 2). Bronchiectasis (cystic fibrosis (CF) or non-CF related) was the main indication for LTx (n = 21), followed by COPD (n = 5). Two patients with a previous pneumonectomy underwent contralateral single LTx and 1 patient with a previous lobectomy had ipsilateral single LTx. The remaining 23 patients underwent bilateral LTx. Clamshell incision was performed in 12 (46%) patients. Moreover, LTx was possible without extracorporeal life support in 13 (50%) patients. 90-day mortality was 8% (n = 2) and the median survival was 8.7 years. CONCLUSIONS History of anatomical lung resection is rare in LTx candidates. The majority of patients are young and diagnosed with bronchiectasis. Although the numbers were limited, survival after LTx in patients with previous anatomical lung resection, including pneumonectomy is comparable to reported conventional LTx for bronchiectasis.

Off-pump lung re-transplantation avoiding clamshell thoracotomy is feasible and safe: a single-center experience

“…However, a multi-center, retrospective analysis from the LTx working group of the European Society of Thoracic Surgeons analysed 2,690 LTx patients between 2005 and 2020, of which 26 had a previous history of anatomical lung resection by open approach. Survival of these patients seemed comparable to conventional LTx patients, thereby indicating that a history of previous thoracic surgery is not an absolute contraindication ( 16 ). In this study, we did not find that the use of clamshell or ECLS during the primary LTx is a prerequisite to use the same approach in re-LTx.…”

Repeated Single-lung Transplantation After Previous Contralateral Pneumonectomy—A Unique Challenge

“… 2 , 3 Contrary to these reports, a recent study by the European Society of Thoracic Surgery Lung Transplantation Working Group claims that any history of anatomic lung resection, including pneumonectomy, results in similar outcomes to conventional lung transplantation. 4 However, the authors here described a small population of patients and included only 2 cases of previous contralateral pneumonectomy.…”

Lung Transplantation in Patients with Previous or Unknown Oncological Disease: Evaluation of Short- and Long-Term Outcomes

“…The introduction of the lung allocation score (LAS) has resulted in an increase in the average age of patients undergoing LTX, and, consequently, an increase in the diagnosis of pre-LTX neoplasia [5]. Despite these current uncertainties, several studies have shown that LTX can be a valid therapeutic option even for patients with a history of oncological disease, as long as specific selection criteria are met and a careful post-transplant monitoring is performed [6][7][8]. The rate of neoplastic recurrence after LTX ranges from 0 to 57%, with the majority reported within the first 5 years post LTX [9].…”