Background: Lung transplantation has long been the accepted therapy for end-stage pulmonary fibrotic disease. Presently, there is an ongoing debate over whether single or bilateral transplantation is the most appropriate treatment for end-stage disease, with a paucity of high-quality evidence comparing the two approaches head-to-head.Results: Overall, 4,212 unique records were identified from the literature search. Following initial screening and the addition of reference list findings, 83 full-text articles were assessed for eligibility, of which 17 were included in the final analysis, with a total of 5,601 patients. Kaplan-Meier survival analysis illustrated improved survival in patients receiving bilateral lung transplantation (BLTx) than in those receiving unilateral transplantation for idiopathic pulmonary fibrosis at all time intervals, with aggregated survival for BLTx at 57%, 35.3% and 24% at 5-, 10-and 15-year follow-up, respectively. Survival rates for SLTx were 50%, 27.8% and 13.9%, respectively. Conclusions:Whilst a number of studies present conflicting results with respect to short-term transplantation outcomes, BLTx confers improved long-term survival over SLTx, with large-scale registries supporting findings from single-and multi-center studies. Through an aggregation of published survival data, this meta-analysis identified improved survival in patients receiving BLTx versus SLTx at all time intervals.

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