Single versus bilateral lung transplantation for idiopathic pulmonary fibrosis: A ten-year institutional experience

Objective: Between July 1988 and July 1998, we performed 433 lung transplan ts. Forty-five patients had idiopathic pulmonary fibrosis, and operations f or these patients included 32 single lung transplants and 13 bilateral sequ ential lung transplants. This study reviews this experience and compares si ngle lung transplantation and bilateral lung transplantation for pulmonary fibrosis. Methods: We performed a retrospective review, including inpatient hospital charts, outpatient clinic records, and telephone contact with patients to v erify current health status. Results: Perioperative mortality was 4 (8.9%) patients, One patient underwe nt redo bilateral lung transplantation for reperfusion injury and graft fai lure after single lung transplantation. The median hospitalization was 22 d ays. Actuarial survival at 1 and 5 years was 75.5% and 53.5%, respectively, which was not significantly different from our survival for all recipients (85.5% and 56.4%, respectively). Seventeen (41%) of 41 operative survivors have died. Late causes of death included obliterative bronchiolitis with r espiratory failure (9), malignancy (3), and cytomegalovirus pneumonitis (2) . Hospital mortality was 3 (9.4%) of 32 after single lung transplantation a nd 1 (7.7%) of 13 after bilateral lung transplantation. There was no differ ence between single and bilateral lung transplantation with regard to hospi tal stay, Four (12.5%) of the 32 patients undergoing single lung transplant ation required tracheostomy, whereas 3 (23%) of 13 recipients undergoing bi lateral lung transplantation required tracheostomy. Conclusion: Single or bilateral lung transplantations offer viable therapy for patients with pulmonary fibrosis. We demonstrate no benefit of bilatera l over single lung transplantation for patients with this diagnosis. Surviv al after transplantation appears better than that of historic control subje cts receiving standard medical care at other institutions.