Prevalence and Impact of Preoperative Peripheral Arterial Disease on Outcomes Following Geriatric Lung Transplantation

Abstract

<h3>Purpose</h3> Elderly patients represent the fast growing population among the end-stage lung disease patients who seek for lung transplantation (LTx); however, their comorbidities often preclude the candidacy for LTx. Peripheral arterial disease (PAD) is one of such outstanding concerns. In this study, we sought the association of preexisting PAD and outcomes after LTx. <h3>Methods</h3> Patients over 70 years old who received LTx at our institution between 2018 and 2020 were enrolled (n=130). Preoperative CT of the abdomen and pelvis was reviewed for all the patients. Vascular calcifications on CT were assessed from distal aorta through femoral arteries by using a semi-quantitative 5-point scale. Then we divided the patients into three groups: mild (1), moderate (2, 3) and severe (4, 5). Data were compared between the three groups. <h3>Results</h3> Thirty-four patients (26%) were in the mild group, 65 patients (50%) were in the moderate group and 31 patients (24%) were in the severe group. Prevalence of pulmonary emphysema and concomitant coronary artery disease was significantly higher in the moderate and severe groups. Regarding the selection of intraoperative mechanical circulatory support including central vs. peripheral, extracorporeal membrane oxygenation vs. cardiopulmonary bypass vs. off-pump, there was no difference among the groups. Postoperatively, the recipients in the severe group demonstrated significantly higher incidences of primary graft dysfunction grade 2-3. Of note, the hospital mortality in the moderate group was the worst (10.8%) followed by the severe (6.5%) and mild groups (2.9%). The 1-year survival for the mild, moderate and severe groups was 90.1%, 81.2% and 87.1%, respectively (Figure 1A), whereas conditional long-term survival appears to be comparable among the groups (Figure 1B). <h3>Conclusion</h3> Pretransplant PAD assessment appears to play an important role in identifying the high risk elderly patients for major vascular complications as well as survival outcomes after LTx.