Single versus Double Lung Transplantation in Pulmonary Fibrosis: Impact of Age and Pulmonary Hypertension.
Ann Thorac Surg. 2018 May 24;:
Authors: Villavicencio MA, Axtell AL, Osho A, Astor T, Roy N, Melnitchouk S, D'Alessandro D, Tolis G, Raz Y, Neuringer I, Sundt TM
BACKGROUND: Double lung transplantation (DLT) has better long-term outcomes compared to single lung transplantation (SLT) in pulmonary fibrosis. However, controversy persists about whether older or high lung allocation score patients would benefit from a DLT. Moreover, the degree of pulmonary hypertension in which a SLT should be avoided is unknown.
METHODS: A retrospective analysis utilizing the UNOS Database was performed in all pulmonary fibrosis lung transplants. Kaplan Meier survival for SLT versus DLT was compared and stratified by age, allocation score, and mean pulmonary artery pressure. Cox regression and propensity-matching analyses were performed.
RESULTS: Between 1987 and 2015; 9,191 out of 29,779 lung transplants were performed in pulmonary fibrosis. Ten-year survival: DLT 55%, SLT 32% (p<0.001). When stratified by age, DLT had improved survival at all age cutoffs, except age ≥ 70. In addition, DLT had improved survival across all lung allocation (< 45, > 45, > 60, > 75) and all pulmonary artery pressure categories (25, > 25, > 30, > 40). Among DLT: pulmonary artery pressure and allocation score did not affect survival. Among SLT, a pressure > 25 did not influence survival. Conversely, a pressure > 30, and allocation score > 45 had decreased survival. On Cox regression and on propensity-matching, DLT had improved survival compared to SLT.
CONCLUSIONS: In pulmonary fibrosis, DLT has improved survival compared to SLT, and should be considered the procedure of choice under the age of 70. SLT with a mean pulmonary artery pressure > 30 and allocation score > 45 should be discouraged.
PMID: 29803692 [PubMed - as supplied by publisher]