Surgical patient outcomes after the increased use of bilateral lung transplantation

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 133; no. 2; pp. 532 - 540
• Main Authors: Chang, Andrew C., MD, Chan, Kevin M., MD, Lonigro, Robert J., MS, Lau, Christine L., MD, Lama, Vibha N., MD, Flaherty, Kevin R., MD, MS, Florn, Ros, RN, Pickens, Allan, MD, Murray, Susan, ScD, Martinez, Fernando J., MD, MS, Orringer, Mark B., MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.02.2007; AATS/WTSA
• Subjects: Adult; Cardiothoracic Surgery; Confidence Intervals; Donor Selection; Evaluation Studies as Topic; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Hospital Mortality - trends; Humans; Lung Diseases - pathology; Lung Diseases - surgery; Lung Transplantation - methods; Lung Transplantation - mortality; Male; Middle Aged; Multivariate Analysis; Postoperative Complications - mortality; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Survival Analysis; Time Factors; Tissue and Organ Procurement - methods; Tissue Donors; Treatment Outcome; Waiting Lists; 12; CI; hazard ratio; International Society of Heart and Lung Transplantation; confidence interval; HR; SRTR; ISHLT; Scientific Registry of Transplant Recipients
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2006.09.060

Objectives 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 are evaluated to determine whether such a policy improves patient outcome. Methods A retrospective analysis of demographic and outcome data for patients undergoing lung transplantation was performed. Patients were grouped as single or double lung recipients and segregated into diagnostic categories according to the lung allocation scoring system. Era terciles were chosen on the basis of year of transplant, operating surgeon, and transplant volume. Results Between November 1990 and September 2005, 344 lung transplant procedures were performed in 339 patients. Over three time periods evaluated, the proportion of patients undergoing double lung transplant procedures increased. Overall survivals at 3 months and 1, 3, and 5 years were 89%, 79%, 60%, and 52%, respectively. After adjusting for lung recipient characteristics, survival after double lung transplantation was improved when compared with single lung transplantation ( P = .020). Overall patient survival among the three time periods was not significantly different at 30 days and 1 and 3 years despite increasing maximal donor organ ischemia times. 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 midterm patient survival has remained higher than nationally reported figures. Bilateral lung transplantation in eligible patients is the procedure of choice.