Graft Side-mismatching for Single-lung Transplantation Does Not Affect Outcomes: Role of the Pre-operative Quantitative Lung Perfusion Scan

Fox, Benjamin D.; Nachum, Ilanit Ben; Bernstine, Hanna; Amital, Anat; Bakal, Ilana; Peled, Nir; Shitrit, David; Kramer, Mordechai R.

doi:10.1016/j.healun.2007.12.005

Cited by 6 publications

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“…The remaining contralateral lung can often ensure adequate oxygenation and hemodynamic stability during the surgical procedure, especially in patients without secondary pulmonary hypertension (e.g., emphysema). This finding therefore suggests that transplanting the 'wrong side' is feasible and should not be considered a contraindication for transplantation [15].…”

Section: Discussionmentioning

confidence: 81%

“…3). Recently, Fox and colleagues reported that graft-side mismatching for perfusion after SLTx does not carry an apparent risk for the recipient, as it can result in similar outcome [15]. The remaining contralateral lung can often ensure adequate oxygenation and hemodynamic stability during the surgical procedure, especially in patients without secondary pulmonary hypertension (e.g., emphysema).…”

Section: Discussionmentioning

confidence: 99%

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Single‐lung transplantation

Bisson

Bonnette²,

N³

et al. 2018

AORN Journal

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Objective: Single-lung transplantation (SLTx) is a valid treatment option for patients with non-suppurative end-stage pulmonary disease. This strategy helps to overcome current organ shortage. Side is usually chosen based on pre-transplant quantitative perfusion scan, unless specific recipient considerations or contralateral lung offer dictates opposite side. It remains largely unknown whether outcome differs between left (L) versus right (R) SLTx. Methods: Between July 1991 and July 2009, 142 first SLTx (M/F = 87/55; age = 59 (29-69) years) were performed from 142 deceased donors (M/F = 81/61; age = 40 (14-66) years) with a median follow-up of 32 (0-202) months. Indications for SLTx were emphysema (55.6%), pulmonary fibrosis (36.6%), primary pulmonary hypertension (0.7%), and others (7.0%). Recipients of L-SLTx (n = 72) and R-SLTx (n = 70) were compared for donor and recipient characteristics and for early and late outcome. Results: Donors of L-SLTx were younger (37 (14-65) vs 43 (16-66) years; p = 0.033). R-SLTx recipients had more often emphysema (67.1% vs 44.4%; p = 0.046) and replacement of native lung with 50% perfusion (47.1% vs 23.6%; p = 0.003). The need for bypass, time to extubation, intensive care unit (ICU) and hospital stay, and 30-day mortality did not differ between groups. Overall survival at 1, 3, and 5 years was 78.4%, 60.5%, and 49.4%, respectively, with a median survival of 60 months, with no significant differences between sides. Forced expiratory volume in 1 s (FEV 1 ) improved ( p < 0.01) in both groups to comparable values up to 36 months. Complications overall (44.4% vs 50.0%) or in allograft (25.0% vs 24.3.0%) as well as time to bronchiolitis obliterans syndrome (BOS) (35 months) and 5-year freedom from BOS (68.9% vs 75.0%) were comparable after L-SLTx versus R-SLTx, respectively. There were no differences in all causes of death ( p = 0.766). On multivariate analysis, BOS was a strong negative predictor for survival (hazard ratio (HR) 6.78; p < 0.001), whereas side and mismatch for perfusion were not. Conclusion: The preferred side for SLTx differed between fibrotic versus emphysema recipients. Transplant side does not influence recipient survival, freedom from BOS, complications, or pulmonary function after SLTx. Besides surgical considerations in the recipient, offer of a donor lung opposite to the preferred side should not be a reason to postpone the transplantation until a better-matched donor is found. #

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%