Challenging conventional criteria for the selection of transplant recipients, Medical Center researchers reported this week that patients who undergo heart procedures are as likely to have successful lung transplants as other patients.
The report is the first major study to look at patients who, directly before receiving a lung transplant, also had a significant heart revascularization--such as a coronary bypass operation. Researchers found that those patients recover as quickly and as well as other transplant recipients, possibly opening the door for some people whom doctors previously considered higher-risk applicants.
Applicants for any organ transplant must meet certain criteria, mainly potential for long-term survival, before they are eligible.
"In certain patients with coronary disease, if you [perform revascularization on them], their survival rate is fairly to close to what would be expected for other patients," said Dr. R. Duane Davis, associate professor of thoracic surgery and one of the researchers who conducted the study. "We felt that, in those situations, there would be very little added risk from the coronaries."
The study examined 350 lung transplants at Duke--the largest performer of lung transplants in the country. Of those, 12 patients underwent bypass surgery, and six had an angioplasty procedure just before the transplant. Their survival rate was about 88 percent, while about 81 percent of other transplant recipients survived.
Dr. Vijay Patel, a clinical associate in thoracic surgery, presented the study results Monday to the 98th annual conference of the American Thoracic Society.
He noted that patients receiving coronary operations did not require a delay in their transplant because doctors can usually perform the first procedure while waiting for a transplant organ to arrive.
"We have shown that we can improve the quality of life of these patients without increasing the amount of time the patient is on the table," Patel said in a statement. "Also, their length of stay in the hospital was similar to those transplant patients who didn't get the revascularization."
Davis also said that many patients with cardiac problems have difficulty getting coverage for transplants from insurance companies, something he said the study may help change.
However, Duke is still one of very few medical centers that regularly combines the operations, Davis added.
He expressed hope that others would follow suit, but he noted that only a select few patients are eligible. Patients who have other heart problems or additional complications may have less success, he said.
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