Single lung transplantation is safe when the other lung is declined†

Abstract

Objectives: Single lung transplant (SLT) is an acceptable treatment modality for certain patients with end-stage lung disease. SLT occurs when two appropriate donor lungs are split between recipients ('split singles') or when one donor lung is adequate for transplant and the other lung is declined ('isolated single'). There is a paucity of literature investigating the outcomes in patients who received an isolated SLT. This study analyses the characteristics and survival outcomes of isolated SLT recipients.

Methods: The transplant database at our institution was queried for all lung transplants between 2010 and 2021. The primary outcome of survival was assessed using Kaplan-Meier curves and Cox regression modelling. Secondary outcomes were assessed using Cox regression and Fisher's exact test.

Results: Of 759 lung transplant recipients, 164 patients underwent a split SLT, and 271 patients underwent an isolated SLT. There was no significant difference when comparing most demographic characteristics between isolated SLT and split SLT patients. Isolated SLT recipients had similar overall mortality when compared to split SLT recipients (HR 0.97, 95% CI 0.72-1.33, P = 0.87). There was no difference in postoperative need for extracorporeal membrane oxygenation (P = 0.209), duration of postoperative ventilation (P = 0.408) and length of hospitalization (P = 0.443).

Conclusions: Our analysis demonstrating similar overall survival between recipients of isolated SLT and split SLT shows that a well-selected isolated donor lung can be used safely in the appropriate recipient population. This practice allows expansion of a known scarce donor lung pool and reduction of the waitlist mortality in lung transplant candidates.

Keywords: Lung transplant; Lung transplant outcomes; Organ allocation; Single lung transplant.