BILATERAL VERSUS SINGLE-LUNG TRANSPLANTATION FOR CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

Objective: Traditionally, despite ventilation/perfusion mismatch, sing le lung transplantation has been the mainstay for end-stage chronic ob structive pulmonary disease, We tested the hypothesis that bilateral s equential lung transplantation has better short- and intermediate-term results than single lung transplantation for chronic obstructive pulm onary disease, Methods: One hundred twenty-six consecutive lung transp lants have been performed from November 1991 to March 1996, Seventy-si x have been for chronic obstructive pulmonary disease, The diagnosis o f this disease includes emphysema (80.3%), alpha(1)-antitrypsin defici ency (9.2%), lymphangioleiomyomatosis (7.9%), and obliterative bronchi olitis (2.6%), Twenty-nine transplants have been bilateral and 47 have been single, Mean age was 55.3 for patients having single lung transp lantation and 48.8 for those having bilateral lung transplantation (p = 0.001), The distribution of the diagnoses was similar between the tw o groups, At 6 months, there were 29 survivors of single lung transpla ntation and 20 survivors of bilateral lung transplantation, with compl ete data for evaluation, Pulmonary function tests and 6-minute walk te sts were evaluated at a mean of 15.4 and 12.8 months after transplanta tion, respectively, Results: Sixty-day mortality was 21.3% for single lung transplantation versus only 3.45% for bilateral lung transplantat ion (p = 0.03), Additionally, Kaplan-Meier analysis revealed 1- and 2- year survivals of 71.1% and 63.3% for single lung transplantation vers us 90% and 90% for bilateral lung transplantation, respectively. Multi ple major morbidities were analyzed, Primary graft failure was signifi cantly reduced in the bilateral group (p = 0.049), Both 6-minute walk tests and forced expiratory volume in 1 second were improved from base line by both single and bilateral lung transplantation (p = 0.001), Co nclusions: Bilateral lung transplantation improves forced expiratory v olume in 1 second and 6-minute walk tests significantly over single lu ng transplantation (p < 0.0001), Both perioperative mortality and Kapl an-Meier survival (to 3 years) are significantly improved when bilater al rather than single lung transplantation is used for chronic obstruc tive pulmonary disease in our series (p < 0.05), This is probably the result of significantly reduced primary graft failure.