Bilateral versus single lung transplantation for chronic obstructive pulmonary disease: Intermediate-term results

Background. There is controversy regarding the transplant procedure of choi ce in chronic obstructive pulmonary disease We reviewed our intermediate-te rm outcomes with single lung transplantation (SLT) versus bilateral lung tr ansplantation (BLT). Methods. We retrospectively reviewed 130 patients with chronic obstructive pulmonary disease: 84 underwent SLT, 46 BLT. The mean age was 51.1 +/- 1.2 years for those who underwent BLT and 56.2 +/- 0.7 years for those who unde rwent SLT (p < 0.0001). Male patients represented 65% of the BLT group and 46% of the SLT group (p = 0.04). Spirometry and 6-minute walk tests were ob tained preoperatively and at 3- to 6-month intervals. Posttransplant surviv al and survival from time of onset of bronchiolitis obliterans syndrome wer e calculated by Kaplan-Meier method. The mean follow-up was 32.4 months. Results. The 90-day mortality rate was 13.0% For BLT and 15.5% for SLT (p = 0.71). Actuarial survival rates at 1, 3, and 5 years were 82.6%, 74.6%, an d 61.9% for BLT and 72.2%, 63.4%, and 57.4% for SLT; the favorable survival trend with BLT did not achieve statistical significance. There were no dif ferences in preoperative spirometry or 6-minute walk tests. The improvement s in forced expiratory volume in one second, forced vital capacity (FVC), a nd 6 MWT were significantly greater following BLT. The incidence of bronchi olitis obliterans syndrome was 22.4% in SLT and 22.2% in BLT; survival foll owing onset of bronchiolitis obliterans syndrome was similar. Conclusions. For patients with chronic obstructive pulmonary disease, BLT i s associated with superior lung function, exercise tolerance, and a trend t oward enhanced survival. Younger candidates may be best suited for BLT. Giv en the limited donor lungs, SLT remains the preferred alternative for all o ther patients. (Ann Thorac Surg 2000;70:1813-9) (C) 2000 by The Society of Thoracic Surgeons.