Outcomes of lung transplant recipients with preoperative atrial fibrillation

Abstract

Background

Preoperative atrial fibrillation is associated with poor outcomes after cardiac surgery, but its effect on lung transplantation outcomes remains unknown.

Methods

We retrospectively reviewed the charts of 235 patients who underwent lung transplantation in our institution from 2013 to 2015, analyzing demographics, length of stay, survival, readmissions, and cardiac events. Mean recipient age was 59 ± 11 years, and 142 (60.4%) were men. Patients were grouped according to pre-transplantation atrial fibrillation status (atrial fibrillation/no atrial fibrillation).

Results

The atrial fibrillation group (n = 38; 16.2%) was significantly older with a longer ischemic time, more postoperative atrial arrhythmias (73.7% vs. 20.8%, p = 0.01), and a longer median postoperative length of stay (16 vs. 13 days, p = 0.02). The median total hospital stay in the first postoperative year was also higher in the atrial fibrillation group (27 vs. 21 days, p = 0.25). Short-term survival and survival during follow-up did not differ significantly between groups.

Conclusions

Lung transplant recipients with preoperative atrial fibrillation are at increased risk of adverse cardiovascular outcomes and longer hospital stay. Preoperative atrial fibrillation may portend adverse events after lung transplantation.

Keywords

Aged Atrial fibrillation Length of stay Lung transplantation Postoperative complications

Get full access to this article

View all access options for this article.

References

Weill

Benden

Corris

et al.

A consensus document for the selection of lung transplant candidates: 2014—an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2015; 34: 1–15.

Yusen

Christie

Edwards

et al.

The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Adult Lung and Heart-Lung Transplant Report—2013; focus theme: age. J Heart Lung Transplant 2013; 32: 951–964.

Biswas Roy

Alarcon

Walia

Chapple

Bremner

Smith

. Is there an age limit to lung transplantation? Ann Thorac Surg 2015; 100: 443–451.

Heeringa

van der Kuip

Hofman

et al.

Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006; 27: 949–953.

Rogers

Angelini

Culliford

Capoun

Ascione

. Coronary surgery in patients with preexisting chronic atrial fibrillation: early and midterm clinical outcome. Ann Thorac Surg 2006; 81: 1676–1682.

Wang

Ramanathan

Choi

Gamble

Ruygrok

. Preoperative atrial fibrillation predicts mortality and morbidity after aortic valve replacement. Interact Cardiovasc Thorac Surg 2014; 19: 218–222.

Bargehr

Trejo-Gutierrez

Rosser

et al.

Liver transplantation in patients with atrial fibrillation. Transplant Proc 2013; 45: 2302–2306.

Vannucci

Rathor

Vachharajani

Chapman

Kangrga

. Atrial fibrillation in patients undergoing liver transplantation-a single-center experience. Transplant Proc 2014; 46: 1432–1437.

Waldron NH, Klinger RY, Hartwig MG, Snyder LD, Daubert JP, Mathew JP. Adverse outcomes associated with postoperative atrial arrhythmias after lung transplantation: A meta-analysis and systematic review of the literature. Clin Transplant 2017;31. Epub 2017 Mar 14.

10.

Jesel

Barraud

Lim

et al.

Early and late atrial arrhythmias after lung transplantation—incidence, predictive factors and impact on mortality. Circ J 2017; 81: 660–667.

11.

Nielsen

Bahnson

Davis

Palmer

. Atrial fibrillation after pulmonary transplant. Chest 2004; 126: 496–500.

12.

See

Roberts-Thomson

Stevenson

Camp

Koplan

. Atrial arrhythmias after lung transplantation: epidemiology, mechanisms at electrophysiology study, and outcomes. Circ Arrhythm Electrophysiol 2009; 2: 504–510.

13.

Fuster

Ryden

Cannom

et al.

2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2011; 123: 1144–1150.

14.

Osho

Castleberry

Yerokun

et al.

Clinical predictors and outcome implications of early readmission in lung transplant recipients. J Heart Lung Transplant 2017; 36: 546–553.

15.

Meluzin

Starek

Kulik

et al.

Prevalence and predictors of early heart failure with preserved ejection fraction in patients with paroxysmal atrial fibrillation. J Card Fail 2017; 23: 558–562.

16.

Burke

Coleman

. Interventions to decrease hospital readmissions: keys for cost-effectiveness. JAMA Intern Med 2013; 173: 695–698.