Surgical Patient Outcomes Following The Increased Utilization Of Bilateral Lung Transplantation
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Objective: Despite the potential limitation of organ availability, several surgical groups have advocated preferential bilateral lung transplantation because of its demonstrated long-term survival advantage. Comparative results for single and sequential double lung transplantation performed at a single center were evaluated to determine whether such a policy would improve patient outcome.
Methods: A retrospective analysis of demographic and outcome data for patients undergoing lung transplantation was performed with IRB approval. Patients were grouped as single (SL) or double (DL) lung recipients, and segregated into three time periods: 1990-95 (T1), 1996-2000 (T2) and 2001-2005 (T3). Kaplan-Meier survival, χ2 test, Student's t-test and ANOVA testing was used to compare groups.
Results: Between November, 1990 and September, 2005, 344 lung transplant procedures were performed in 339 patients. Five SL recipients required SL retransplantation. Over the three time periods evaluated(Table), the proportion of patients undergoing DL procedures increased from 22% to 33%(p<0.0001a) . Diagnostic acuity also increased, with a greater percentage of patients undergoing transplantation for either pulmonary fibrotic (PF) disease (16% to 26%), or cystic fibrosis/bronchiectasis (1% to 11%), while fewer patients with obstructive lung disease (72% to 57%) underwent transplantation. Overall, thirty-day mortality was 8.9% (30/339), including two patients who died following SL retransplantation. When compared to SL transplantation, DL survival was better at 1(85% vs 77%), 3(71% vs 58%) and 5(65% vs 50%) years(p=0.01). Overall patient survival between the three time periods was not significantly different at 30 days, 1 and 3-years (Table) despite increasing maximal donor organ ischemia times from a median of 212 minutes (T1) to 282 minutes (T3)(T3 vs. T1 or T2, p<0.05b).
Conclusions: In this single center study, despite longer median allograft ischemic times as well as greater patient acuity, as determined by listing diagnosis, overall early and mid-term patient survival has remained higher than reported national expectations. In addition, improved outcomes of our BL transplant recipients when compared to SL patients confirms that bilateral lung transplantation in eligible patients is the procedure of choice.
Lung transplantation by time, donor organ ischemia and patient survival | | | | | %Survival (95% CI) |
| Period | N | %SL (n) | %DL (n)a | Median Ischemiab,
min(range) | 30-day | 1-year | 3-year |
| T1 | 85 | 78(66) | 22(19) | 212 (96-540) | 89.4 (80.6-90.3) | 78.8 (68.5-86.1) | 61.2 (50.0-70.6) |
| T2 | 129 | 91(117) | 9(12) | 231 (76-395) | 88.4 (81.5-92.8) | 74.4 (66.0-81.1) | 55.8 (46.8-63.9) |
| T3 | 130 | 67(87) | 33(43) | 282 (124-547) | 95.4 (90.0-97.9) | 83.1 (75.0-88.8) | 65.1 (54.1-74.1) |
| Total | 344 | 100 (270) | 100 (74) | | | | |
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