Double lung, unlike single lung transplantation might provide a protective effect on mortality and bronchiolitis obliterans syndrome

Abstract

Background: Survival after lung transplantation (LTx) is often limited by bronchiolitis obliterans syndrome (BOS). Method: Survey of 278 recipients who underwent LTx. The endpoint used was BOS (BOS grade ≥ 2), death or Relung transplantation (Re-LTx) assessed by competing risk regression analyses. Results: The incidence of BOS grade ≥ 2 among double LTx (DLTx) recipients was 16 ± 3% at 5 years, 30 ± 4% at 10 years, and 37 ± 5% at 20 years, compared to single LTx (SLTx) recipients whose corresponding incidence of BOS grade ≥ 2 was 11 ± 3%, 20 ± 4%, and 24 ± 5% at 5, 10, and 20 years, respectively (p > 0. 05). The incidence of BOS grade ≥ 2 by major indications ranked in descending order: other, PF, CF, COPD, PH and AAT1 (p < 0. 05). The mortality rate by major indication ranked in descending order: COPD, PH, AAT1, PF, Other and CF (p < 0. 05). Conclusion: No differences were seen in the incidence of BOS grade ≥ 2 regarding type of transplant, however, DLTx recipients showed a better chance of survival despite developing BOS compared to SLTx recipients. The highest incidence of BOS was seen among CF, PF, COPD, PH, and AAT1 recipients in descending order, however, CF and PF recipients showed a better chance of survival despite developing BOS compared to COPD, PH, and AAT1 recipients.

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

“…Furthermore, a lower rate of BOS and better survival despite developing BOS were found in the BLT group. 45 Chronic lung allograft dysfunction, especially BOS, remains the main cause of long-term mortality without a particularly effective treatment to address it. The lower rate of BOS and native lung complications might result in a higher BFS and long-term survival; and (3) the mean age of patients who underwent BLT was lower than that of the SLT group (only 2/30 studies showed a higher mean age for the SLT group).…”

The influence of the native lung on early outcomes and survival after single lung transplantation

“…The main advantages of this procedure are a quicker and less aggressive surgery, decreased organ ischemic time, and a more efficient use of the scarce lung donor pool by performing twinning procedures (two recipients transplanted from the same donor), which decreases the mortality rate while on the waiting list [ 11 ]. On the other hand, a poorer survival among patients undergoing a SLT has been reported [ 2 , 6 , 7 ].…”

“…The longer survival of BLT has been related to a better postoperative lung function and less chronic lung allograft dysfunction (CLAD) compared with unilateral procedures [ 6 , 7 ]. However, there is little evidence demonstrating that the native lung could be the cause of a worst survival after a SLT.…”

Lung Transplantation: A Final Option for End-Stage Interstitial Lung Diseases

“…BOS, a form of chronic lung allograft dysfunction, is the biggest factor hampering long-term outcome. Regrettably, it is likewise a common obstacle in LTx, where LTx recipients in general experience an incidence of almost 30% after 2 years and three quarters of recipients experience this pathology after 10 years [77,82]. Recipients with IPF have a greater hazard of contracting PGD and therefore a greater hazard of BOS, where it is proposed that this patient group have steeper deterioration in lung function and greater risk of mortality than recipients without IPF that has been exposed to BOS [83,84].…”