Bilateral Lung Transplantation Provides Better Long-term Survival and Pulmonary Function Than Single Lung Transplantation: A Systematic Review and Meta-analysis

Abstract

Background. Both bilateral lung transplantation (BLT) and single lung transplantation (SLT) are commonly used, but which method is better remains controversial. This meta-analysis was conducted to compare the 2 surgical procedures to identify a better clinical choice. Methods. Cohort studies comparing SLT and BLT were identified by conducting searches of databases and screening references of retrieved articles. Survival, pulmonary function, surgical indicators, and complications were compared between the 2 groups. Results. Thirty studies (1980 recipients in the SLT group and 2112 recipients in the BLT group) were pooled in the meta-analysis. The long-term overall survival rate (OSR) (OSR-4y and OSR-5y), bronchiolitis obliterans syndrome (BOS)-free survival, BOS-free survival rate (BFSR) (2-5 y), 6-minute walking distance, forced expiratory volume in 1 second (%), forced vital capacity (%), oxygenation index, pulmonary arterial pressure, Arterial partial pressure of oxygen (P a o 2 ), diffusing capacity of the lung for carbon monoxide (D lco ), and BOS were better in the BLT group than in the SLT group. The advantages shown in the BLT group compared with the SLT group in regard to these variables increased with the prolongation of survival time. However, surgical time, ischemic time, postoperative intensive care unit days, and postoperative hospital days were shorter in the SLT group than in the BLT group. Overall survival, short-term OSR (1-3 y), BSFR-1y, in-hospital mortality, postoperative ventilator days, and postoperative complications (except BOS) were similar between the 2 groups. Bacterial pneumonia, graft failure, fungal infection, cardiac arrhythmia, and hemorrhage were the top 5 causes of in-hospital mortality. Conclusions. BLT appears to be associated with better long-term survival, better postoperative lung function, and less BOS compared with SLT. In-hospital mortality and postoperative complications (except BOS) were similar between the 2 groups.

Survival following lung transplantation: A population‐based nested case‐control study

“…Patients with cystic fibrosis and immunodeficiency disorders had the lowest SMR compared to other diagnosis groups, which is consistent with previous reports evaluating posttransplant prognosis in this cohort 2 . Double lung recipients also experienced lower standardized mortality compared to single lung recipients, which is again consistent with prior estimates, and likely because of the lower pulmonary reserve and the higher number of native lung complications in these immunosuppressed recipients 8 . Additionally, these results indicate that standardized mortality of transplant recipients has declined over time, which is likely multifactorial and attributable to advancements in regionalization, improved immunosuppressive management of acute rejection, 9 management of infections, utilization of anti‐reflux procedures, 10,11 and donor‐recipient matching algorithms 12–15 …”

“…SMRs vary substantially among demographic groups with women, Hispanic, and younger recipients experiencing the largest gaps in survival when comdisorders had the lowest SMR compared to other diagnosis groups, which is consistent with previous reports evaluating posttransplant prognosis in this cohort 2. Double lung recipients also experienced lower standardized mortality compared to single lung recipients, which is again consistent with prior estimates, and likely because of the lower pulmonary reserve and the higher number of native lung complications in these immunosuppressed recipients 8. Additionally,F I G U R E 2 Observed survival of lung transplant recipients versus noninstitutionalized inhabitants of the United States.…”

Pediatric lung transplantation in the largest lung transplantation center of China: embarking on a long road

“…Similarly, in our study, all cases received BLT. Evidence suggests that patients receiving BLT appear to have longer survival and better functional outcomes after transplantation 9 , 10 .…”

Distinct molecular and immunological properties of circulating exosomes isolated from pediatric lung transplant recipients with bronchiolitis obliterans syndrome ‐ a retrospective study

“…Chronic lung allograft dysfunction currently includes both restrictive airway disease and an obstructive pathology known as bronchiolitis obliterans syndrome (BOS). Roughly 40% of pediatric LTx recipients (LTxRs) develop BOS within 5 years of LTx [4,5], however, the mechanisms underlying BOS development remain unclear.…”