Impact of previous cardiovascular disease on the outcome of lung transplantation

Background: The impact of previous cardiovascular disease on the outcome of lung transplantation may be important but remains unstudied.

Methods: Cardiovascular risk factors, echocardiography, right heart catheterization, isotopic ventriculography and vascular ultrasonography data were obtained from 258 adults who underwent lung transplantation at our center between 1988 and 2007. The effect of these parameters on survival and cardiovascular disease after transplantation was determined using the Cox model.

Results: By multivariate analysis, diabetes (hazard ratio [HR]: 2.4), atrial fibrillation (HR: 3.51), elevated systolic pulmonary artery pressure (HR: 1.23 per 10 mm Hg) and low cardiac index (HR: 1.47 per-liters/min/m(2)) before transplantation were associated with a higher risk of death after transplantation. Heart failure (2.08 cases per 100 patient-years) and atherothrombosis (2.5 cases per 100 patient-years) were frequent after lung transplantation. A history of atherothrombosis (HR: 12.98) and diabetes (HR: 5.8) before transplantation were associated with a higher risk of atherothrombosis after transplantation. Major cardiovascular events led to death in 11 patients. Diabetes (HR: 62.5) and a low cardiac index (HR: 6.8 per-liters/min/m(2)) were associated with a higher risk of death from cardiovascular causes.

Conclusions: Diabetes and a history of atrial fibrillation before lung transplantation were associated with excess mortality after transplantation. Diabetes was also associated with a major increase in the risk of atherothrombosis and death from cardiovascular causes. Lung transplant recipients may be considered at high risk for cardiovascular disease.