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. 2021 Oct 29;33(5):807-813.
doi: 10.1093/icvts/ivab169.

Comparing outcomes in patients with end-stage chronic obstructive pulmonary disease: single versus bilateral lung transplants

Sudeep Mutyala  1   2 , M Abul Kashem  1   2 , Jay Kanaparthi  1   2 , Gengo Sunagawa  1   2 , Manish Suryapalam  2 , Eros Leotta  1   2 , Kenji Minakata  1   2 , Stacey Brann  1   2 , Norihisa Shigemura  1   2 , Yoshiya Toyoda  1   2
Affiliations

Comparing outcomes in patients with end-stage chronic obstructive pulmonary disease: single versus bilateral lung transplants

Sudeep Mutyala et al. Interact Cardiovasc Thorac Surg. .

Abstract

Objectives: Debate continues on whether a bilateral (BLT) or a single lung transplantation (SLT) is preferred for patients with end-stage chronic obstructive pulmonary disease (COPD). The purpose of this study is to examine the interplay between patient age and transplant type on survival outcomes.

Methods: We performed a retrospective study of lung transplants for COPD at our centre from February 2012 to March 2020 (n = 186). Demographics and clinical parameters were compared between patients based on their age (≤65 vs >65 years old) and type of transplant (single vs bilateral). Cox proportional hazards regression was also performed. P-values <0.05 were considered significant.

Results: Of the 186 patients with COPD who received lung transplants, 71 (38.2%) received BLTs and 115 (61.8%) received SLTs. There was no significant difference in survival outcomes when looking at patients with single versus BLTs (P = 0.870). There was also no difference in survival between the 2 age groups ≤65 versus > 65 years (P = 0.723). The Cox model itself also did not show a statistically significant improvement in survival outcomes (P = 0.126).

Conclusions: Lung transplant outcomes in patients with end-stage COPD demonstrated non-inferior results in patients with an SLT compared to patients with a BLT. When we compared the age groups, neither transplant type showed superior survival benefits, suggesting there may be some utility in an SLT in younger recipients.

Keywords: Bilateral lung transplantation; Chronic obstructive pulmonary disease; Single lung transplantation; Survival outcome.

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Figures

Figure 1:
Figure 1:
KM curve showing no survival differences in transplant types compared for significance (P < 0.05) between the groups. Patients with a bilateral lung transplantation had a median survival of 4.11 years, with 56 alive 5 years post-transplant patients. Patients with a single lung transplantation had a median survival of 4.05 years, with 95 alive at 5 years post-transplant. COPD: chronic obstructive pulmonary disease; KM: Kaplan–Meier.
Figure 2:
Figure 2:
KM curve showing no survival differences in cohort age compared for significance (P < 0.05) between the groups. A total of ≤65 patients had a median survival of 4.15 years, with 81 alive at 5 years post-transplant; >65 patients had a median survival of 4.11 years, with 70 alive at 5 years post-transplant. COPD: chronic obstructive pulmonary disease; KM: Kaplan–Meier.
Figure 3:
Figure 3:
KM curve showing no survival differences in transplant types compared for significance (P < 0.05) in recipients at or under 65 years. Patients with a single lung transplantation had a median survival of 4.18 years, with 49 alive at 5 years post-transplant. Patients with a bilateral lung transplantation had a median survival of 4.18 years, with 32 alive at 5 years post-transplant. COPD: chronic obstructive pulmonary disease; KM: Kaplan–Meier.
Figure 4:
Figure 4:
KM curve showing no survival differences in transplant types compared for significance (P < 0.05) in recipients over 65 years. Patients with a single lung transplantation had a median survival of 3.25 years, with 46 alive at 5 years post-transplant. Patients with a bilateral lung transplant had a median survival of 4.02 years, with 24 alive at 5 years post-transplant. COPD: chronic obstructive pulmonary disease; KM: Kaplan–Meier.
None
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References

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