Bilateral Lung Transplantation Provides Better Long-term Survival and Pulmonary Function Than Single Lung Transplantation: A Systematic Review and Meta-analysis

Abstract

Background: Both bilateral lung transplantation (BLT) and single lung transplantation (SLT) are commonly used, but which method is better remains controversial. This meta-analysis was conducted to compare the 2 surgical procedures to identify a better clinical choice.

Methods: Cohort studies comparing SLT and BLT were identified by conducting searches of databases and screening references of retrieved articles. Survival, pulmonary function, surgical indicators, and complications were compared between the 2 groups.

Results: Thirty studies (1980 recipients in the SLT group and 2112 recipients in the BLT group) were pooled in the meta-analysis. The long-term overall survival rate (OSR) (OSR-4y and OSR-5y), bronchiolitis obliterans syndrome (BOS)-free survival, BOS-free survival rate (BFSR) (2-5 y), 6-minute walking distance, forced expiratory volume in 1 second (%), forced vital capacity (%), oxygenation index, pulmonary arterial pressure, Arterial partial pressure of oxygen (Pao2), diffusing capacity of the lung for carbon monoxide (Dlco), and BOS were better in the BLT group than in the SLT group. The advantages shown in the BLT group compared with the SLT group in regard to these variables increased with the prolongation of survival time. However, surgical time, ischemic time, postoperative intensive care unit days, and postoperative hospital days were shorter in the SLT group than in the BLT group. Overall survival, short-term OSR (1-3 y), BSFR-1y, in-hospital mortality, postoperative ventilator days, and postoperative complications (except BOS) were similar between the 2 groups. Bacterial pneumonia, graft failure, fungal infection, cardiac arrhythmia, and hemorrhage were the top 5 causes of in-hospital mortality.

Conclusions: BLT appears to be associated with better long-term survival, better postoperative lung function, and less BOS compared with SLT. In-hospital mortality and postoperative complications (except BOS) were similar between the 2 groups.