P246 Lung Transplantation For Patients With Idiopathic Pulmonary Fibrosis And Asymptomatic Coronary Artery Disease

Abstract

Introduction and objectives Lung transplantation significantly improves the survival of patients with advanced idiopathic pulmonary fibrosis (IPF). Concurrent coronary artery disease (CAD) is a relative contraindication to transplantation and can limit access to this therapy. This is particularly relevant as a high prevalence of CAD has been reported in patients with IPF.1 We sought to determine whether the presence of asymptomatic CAD impacted upon post-transplant survival. Methods This retrospective study reviewed all patients who had undergone single lung transplantation for IPF at our centre, between May 2005 to April 2014. We compared post-surgical outcomes for patients with IPF who had an abnormal coronary angiogram (at the time of transplant listing), to those with normal angiography. Kaplan-Meier curves were created to study survival and univarate analysis performed using the Log-Rank score. Results In this timeframe, 39 patients underwent lung transplantation for IPF, of which 22 patients (56.4%) had abnormal coronary angiography. Eight of these patients had minor disease, 5 had 10–30% stenosis and 5 had 30–50% stenosis. One patient required coronary artery stenting prior to transplantation, but 3 patients with ≥70% stenosis had no inducible ischaemia on dobutamine stress testing and were managed conservatively. All patients had normal pre-operative left ventricular function. The post-transplant survival of patients with IPF and CAD was 95.7% at 1 year and 70.1% at 5 years. There was no significant difference in survival (p = 0.52) between the cohort with CAD and those with normal pre-operative coronary angiograms. Of note, 1 patient required coronary artery stenting 18 months after transplantation (this patient had 30% LAD stenosis at time of listing). No patients developed chronic arrhythmias, and no patients died as a result of cardiovascular disease. Conclusion Although CAD remains a relative contraindication to transplantation, the effects of previous PCI or minor CAD are unknown and may be overstated. This finding is particularly relevant for patients with IPF, who may have an increased prevalence of CAD. Reference Raghu G, Weycker D, Edelsberg J, Bradford WZ, Oster G. Incidence and prevalence of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2006;174(7):810-6