Abstract
A single lung transplant (SLT) is a viable intervention for patients with surgical or medical contraindications to bilateral LT (BLT). SLT is typically favored in patients with prior thoracic or cardiac surgery, unilateral chest wall contraction, or advanced age or frailty as it can be a faster operation with reduced risk of intraoperative complications. Furthermore, SLT may reduce waitlist times and mortality as two recipients can benefit from one donor. We sought to compare clinical outcomes of SLT recipients (SLTRs) to matched BLT recipients (BLTRs).
With IRB approval, SLTRs transplanted between January 2011 and September 2021 were identified and matched with BLTRs on age, gender, lung allocation score, year of transplant, and indication for transplant. Primary outcomes were 1- and 3-year survival; the secondary outcome was CLAD-free survival.
A total of 198 patients were included in the analysis (29 SLTRs and 169 BLTRs). Pre- and posttransplant characteristics are listed in Table 1; bold values indicate statistical significance. CLAD-free survival was similar between the two groups (78.6% vs 84.6%, p=0.753), but SLTRs had a lower 1- and 3-year survival probability (75.9% vs 89.3%, p=0.047 and 55.2% vs 75.1%, p=0.044; Figure 1).
Despite comparable post-LT morbidity, the probability of surviving to 1 and 3 years after transplant was significantly lower among SLTRs than BLTRs. The risk of reduced post-LT long-term survival must be balanced with the risk of waitlist mortality or the risk of BLT when considering single organ allocation.