Single lung transplantation has equivalent long term outcomes to bilateral lung transplantation in patients with pulmonary hypertension associated with advanced lung disease

Abstract

Whether bilateral lung transplantation (BLT) rather than single lung transplantation (SLT) should be preferentially performed for patients with World Health Association (WHO) Group 3 pulmonary hypertension (PH) associated with advanced lung disease has been controversial. We retrospectively examined the outcomes of 474 consecutive patients who underwent BLT or SLT at our center between 1999 and 2013. After exclusion of patients with cystic fibrosis or those undergoing retransplantation, 179 patients with PH were split into four groups based on their pulmonary artery pressure values (mild versus severe) and transplant type (BLT versus SLT). The incidence of grade 2-3 primary graft dysfunction and mechanical ventilation >48 hours was significantly higher for the BLT versus the SLT recipients. However, long-term survival via the Kaplan-Meier method and appropriate log rank tests did not differ significantly among the four cohorts. Because long-term outcomes for patients who undergo SLT for advanced lung disease associated with WHO Group 3 PH did not differ significantly from those for BLT recipients, even if PH was severe, we suggest that SLT can be performed safely in patients with Group 3 PH associated with ALD and potentially allows improved donor organ utilization.