Outcomes from paired single-lung transplants from the same donor

Background and Methods: Simultaneous, paired single-lung transplants from a single organ donor is one way to maximize lung transplant opportunities. P aired transplants allow comparison between left and right single-lung trans plants and also provide insight into the relevance of donor vs recipient fa ctors in rejection outcomes. Results: Of 76 paired transplants (38 pairs) performed at the Alfred Hospit al, 68 patients have survived >30 days. We observed no significant differen ces between left and right single-lung transplants in ICU stay (median, 3.1 vs 3.0 days; range, 0.5 to 83 vs 0.5 to 76 days), hospital stay (median, 1 9.5 vs 24.0 days; range, 1 to 118 vs 11 to 144 days), airway complications (5 vs 3), and 5-year survival (60% vs 50%). The 6 month, and 1- and 2-year survivals were lower in left single-lung transplant recipients, primarily r elated to increased mortality from airway complications. In 28 pairs, both recipients survived 90 days, and the incidence, frequency, and time of onse t of acute rejection and chronic rejection (bronchiolitis obliterans syndro me [BOS]) were not significantly different. When sequentially performed lun g transplants were separately analyzed, the incidence of acute rejection wa s not related to graft ischemic time. Conclusions: The general outcomes of right and left transplants are similar , although we observed increased 6-month to 2-year mortality associated wit h left lung transplantation. The lack of correlation between the incidence of acute rejection episodes or the severity of BOS in paired allograft reci pients suggests that "donor factors" are not the dominant cause.