Surgical and Endoscopic Lung Volume Reduction (LVR) Prior to Lung Transplantation (LuTX)

Abstract

Purpose Although lung transplantation and lung volume reduction (both surgically and endoscopically: LVRS/ELVR) are well established therapies for end-stage emphysema patients, data on LVR prior to LuTX remains scarce. Thus, we aim to analyze the impact of pre-transplant LVR on post-LuTX outcomes. Methods From 1/2015 to 5/2018, 55 patients underwent bilateral LuTX for COPD and α1-AT deficiency at our center. Of those, 7 patients (12.7%) had surgical LVR prior to LuTX and 14 (25.5%) had endoscopic LVR. Those patients were compared to the other 34 patients without previous intervention. Data is presented as LVRS (n=7) vs. ELVR (n=14) vs. controls (n=34). Results Despite a significantly different distribution in sex (female: 21.4% vs. 57.1% vs. 64.7%; p=0.023), no other differences were observed in all other recipient characteristics (age: 58 vs 56 vs. 56 years | BMI: 23.2 vs. 20.9 vs. 22.15 | TLCr: 9.6 vs. 7.9 vs. 7.8L | PAP: 33 vs. 30 vs. 30mmHg | waiting time: 271 (15-2350) vs. 747 (48-2161) vs. 1098 (6-3962) days). The lung allocation score (LAS) at time of LuTX did not show any clinically relevant differences between the three groups (32.5 vs. 32.2 vs. 32.9; p=0.028). 4 patients underwent bilateral LVRS, 3 unilateral LVRS. ELVR was performed with valves in 9 cases and with coils in 6 cases, evenly distributed in all lobes. Median duration from LVR to listing for LuTX was 303 (LVRS) and 508 (ELVR) days. Median duration from LVR to LuTX was 961 (397-3194) and 823 (8-2704) days respectively. After LuTX no significant differences were observed in ICU stay (7 vs. 10 vs. 11 days), hospitalization (48 vs. 41 vs. 51 days) and lung function (3-months post-LuTX FEV1: 80% vs. 78% vs. 79% | 3-months RV: 118% vs. 120% vs. 125%). No significant differences were observed in survival (1 and 3year survival: 100% vs. 100% vs. 85.3; p=0.07). Conclusion In our recent cohort of patients, LVRS and ELVR prior to lung transplantation did not impact short- and medium-term post-LuTX outcomes. Although the benefit and the precise indications of the different LVR methods remain to be elucidated in prospective trials, LVRS and ELVR can be safely considered for patients prior to lung transplantation.