Single lung transplantation remains a viable treatment option in selected patients
R.A.S. Hoek, L. Seghers, E. Mahtab, J.A. Bekkers, H.C. Hoogsteden, M.E. Hellemons
Friday 16 march 2018
11:30 - 11:40h
at Willem Burger Zaal
Categories: Clinical, Session (parallel)
Parallel session: Parallel session 13: Clinical
Introduction
Lung transplantation is an accepted therapy for end-stage pulmonary disease. Over the last decades the proportion of single lung transplantation (SLT) as opposed to double lung transplantation (DLT) has decreased considerably worldwide for all indications, as median survival rates are generally lower in SLT than DLT (4.6 versus 7.4 years; International heart and lung transplantation registry data). Despite this, SLT may have important advantages: more patients can be helped with fewer organs, size-match can be more easily achieved and surgery is less extensive which may benefit especially older patients with pulmonary fibrosis. In our cohort we see these important benefits of SLT in selected groups of patients and aimed to assess the outcomes of SLT in our center.
Methods
We retrospectively assessed all SLT en DLT performed at our center from 2002-2017. We collected patient characteristics and assessed outcomes, such as waitinglist time, hospital and ICU stay, survival and development of obstructive chronic lung allograft dysfunction (oCLAD) and compared these between SLT en DLT using descriptive statistics and survival analyses.
Results
We performed 40 SLT and 152 DLT. Indications for SLT were most commonly pulmonary fibrosis (in 30% of cases) or COPD (in 27%), whereas all patients with cystic fibrosis and pulmonary hypertension underwent DLT. SLT recipients were older (57 vs 50 years, P=0.007). Donor characteristics were similar between recipients of SLT and DLT.
Waitinglist time was shorter in the SLT group (0.9 vs 1.2 years, P=0.01) and patients less frequently had to be transplanted from high-urgency status or high LAS status (25% versus 44%, P=0.03). Postoperative ICU (4 vs 11 days, P<0.001) and hospital stay (29 vs 39 days, P=0.003) were shorter in SLT than DLT. Survival at 1 and 5 years was not statistically different (95% and 72% in ] SLT and 82% and 74% in ] DLT; P-logrank NS). Freedom from oCLAD at 1 and 5 year was also comparable (97% and 77% in SLT and 98% and 78% in DLT, P-logrank=NS).
Conclusion
Whereas worldwide SLT is increasingly less used as it is associated with poorer survival, our centers experience is that SLT remains a viable treatment option for selected patients that is associated with shorter waiting time, shorted ICU and hospital stay and comparable short and long term patients and allograft survival.
