Comparative Outcomes Of Lung Volume Reduction Surgery And Lung Transplantation: A Systematic Review And Meta-Analysis
Danial Ahmad1, Brandon Ferrell2, Abhiraj Saxena1, Diana C. Jimenez1, Thomas J. O'Malley1, Bryan A. Whitson3, Vakhtang Tchantchaleishvili1.
1Thomas Jefferson University, Philadelphia, PA, USA, 2Montefiore Medical Center, New York, NY, USA, 3The Ohio State University, Columbus, OH, USA.
Background: There is insufficient data on how Lung volume reduction surgery (LVRS) compares with lung transplantation (LTx). We sought to pool the existing evidence from prospective studies on LVRS outside the National Emphysema Treatment Trial, and compare the results with pooled prospective LTx studies.
Methods: An electronic search was performed to identify all relevant studies published from 2000-2019. Baseline characteristics, comorbidities, perioperative variables, and clinical outcomes were extracted for meta-analysis.
Results: The analysis included 71 prospective studies comprising of 3794 patients, including 51 studies on LVRS (n=2220) and 20 studies on LTx (n=1574). Mean age was 59 (95%CI: 45, 73) years and comparable between the two groups. Females were 28% (95%CI: 22, 37) in LVRS group vs 51% (95%CI: 30, 71) in the LTx group (p = 0.05). Baseline 6-minute walk test (6MWT) and pulmonary function tests were comparable except for the FEV1, which was lower in the LTx group [20.2% (95%CI: 17.8, 22.5) vs 27.7 (95% CI: 25.9, 29.6), p<0.01]. Postoperatively, both groups experienced improved FEV1, however Post-LTx FEV1 was significantly higher than post-LVRS FEV1 [61.2% (95%CI: 52.9, 70.5) vs 32.5% (95%CI: 30.1, 34.8), p<0.01]. 6MWT was also improved after surgery [LVRS: 306.6m (95%CI: 289.2, 324.0) to 409.1m (95%CI: 392.1, 426.0), p<0.01; LTx: 235.4m (95%CI: 150.7, 320.0) to 454.4m (95%CI: 334.7, 574.2), p<0.01], however, with no significant difference between the groups. Pooled survival over time (figure) shows no significant difference between the groups.
Conclusions: LTx results in better FEV1 but otherwise has comparable outcomes to LVRS.
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