Single-lung transplantation in emphysema: Retrospective study analyzing survival and waiting list mortality

Abstract

AIM:To performed remains a subject of debate and is the principal aim of the study. METHODS:This retrospective analysis included 73 patients with emphysema (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012). The outcomes of patients undergoing single-lung transplantation (SL) (n = 40) or double-lung transplant (DL) (n = 33) were compared in a Cox multivariate analysis to study the impact of the technique, postoperative complications and acute and chronic rejection on survival rates. Patients were selected for inclusion in the waiting list according to the International Society of Heart Lung Transplantation criteria. Pre and postoperative rehabilitation and prophylaxis, surgical technique and immunosuppressive treatment were similar in every patients. Lung transplantation waiting list information on a national level and retrospective data on emphysema patient survival transplanted in Spain during the study period, was obtained from the lung transplantation registry managed by the National Transplant Organization (ONT). RESULTS:Both groups were comparable in terms of gender and clinical characteristics. We found significant differences in the mean age between the groups, the DL patients being younger as expected from the inclusion criteria. Perioperative complications occurred in 27.6% SL vs 54% DL (P = 0.032). Excluding perioperative mortality, median survival was 65.3 mo for SL and 59.4 mo for DL (P = 0.96). Bronchiolitis obliterans and overall 5-year survival were similar in both groups. Bacterial Core tip: This is a retrospective and comparative study of 2 cohort of patients with advanced-stage emphysema who were performed uni or bilateral lung transplant. The results of this study support the realization of singlelung transplantation in most of the cases of emphysema because it is technically simpler, it has less risk of surgical sutures, and finally it has less immediate postoperative complications. Single and double lung transplantation has a similar long-term survival. Moreover, if a second transplant is needed in the long-term, the contralateral transplantation has the same initial transplant survival if the patient remains in a similar clinical situation. Survival Spanish national register does not show difference between the two techniques too, supporting the results of our relatively small series. This strategy of performing single lung transplantation in most of the cases of emphysema would encourage and enhance the use of donors thanks to the twining procedure, and would decrease mortality in the waiting list as shown in the National Transplant Organization patients analysed. Proper pre and postoperative prophylaxis and postoperative early extubation protocol is essential to achieve good results.Borro JM, Delgado M, Coll E, Pita S. Singlelung transplantation in emphysema: Retrospective study analyzing survival and waiting list mortality. World J Transplant 2016; 6(2): 347355 Available from:

Procedure Preference and Intention-to-Treat Outcomes after Listing for Lung Transplantation among U.S. Adults. A Cohort Study

“…Consistent with prior work, a less restrictive preference was associated with a lower waiting list mortality rate and a higher transplantation rate in ILD (27,28). This study extends those findings to COPD (27,29,30). In short, we failed to find any substantial benefit to restricting patients with COPD or ILD to a bilateral transplant procedure.…”

<p>Trends and hospital outcomes of lung transplantation among patients with and without chronic obstructive pulmonary disease in Spain: a national population-based study (2001&ndash;2015)</p>

“…In another retrospective analysis conducted in Spain, it was demonstrated that single or double LTx had no impact on patient survival or complications. Implementing single LTx widely may alleviate donor-organ shortages and contribute to decreases in the morbidity and mortality of those patients on the national waiting list 24. Like other authors, we observed a predominance of males in the patients who underwent LTx in Spain 3.…”

Lung volume reduction followed by lung transplantation—considerations on selection criteria and outcome

“…Also, LVRS of the native lung at the same time of LuTX was reported in four patients were hyperinflation was to be expected (65)(66)(67). More recently ELVR was used to counteract NLH (51,65,(68)(69)(70)(71). All reports share a high rate of success in terms of improving lung function and reducing subjective breathlessness of patients affected by NLH.…”

“…It is characterized by a radiographic evidence of graft compression and the decrease in lung function and exercise tolerance. Even if the first reports about LVRS as a method of treatment of this condition date back to 1997, only 11 case reports/case series with a total of 44 patients have been published so far (3,(56)(57)(58)(59)(60)(61)(62)(63)(64)(65). Also, LVRS of the native lung at the same time of LuTX was reported in four patients were hyperinflation was to be expected (65)(66)(67).…”

“…Even if the first reports about LVRS as a method of treatment of this condition date back to 1997, only 11 case reports/case series with a total of 44 patients have been published so far (3,(56)(57)(58)(59)(60)(61)(62)(63)(64)(65). Also, LVRS of the native lung at the same time of LuTX was reported in four patients were hyperinflation was to be expected (65)(66)(67). More recently ELVR was used to counteract NLH (51,65,(68)(69)(70)(71).…”