Single lung transplantation for pulmonary fibrosis: Does side matter?

TL;DR

This study examines whether single lung transplants for pulmonary fibrosis patients lead to good long-term outcomes and if the lung side (left or right) affects results.

Contribution

The study demonstrates that single lung transplantation for pulmonary fibrosis is effective regardless of the graft side, aiding donor organ utilization.

Findings

Survival rates at 1, 5, and 10 years were 83%, 59%, and 29% for all patients.

Left and right single lung transplants showed similar survival and lung function outcomes.

Postoperative pneumonia and sepsis were significant predictors of early mortality.

Abstract

The implementation of the Lung Allocation Score in the Eurotransplant international collaborative framework decreased waiting list mortality, but organ shortage remains a significant problem. Single lung transplantation (sLTx)—whenever possible—may decrease waiting list mortality. We have consistently employed sLTx for recipients with pulmonary fibrosis. In the current investigation, we sought to analyze if this strategy can lead to an acceptable long-term outcome and if the side of sLTx has an impact on the outcome.

Between 1995 and 2024, we performed 138 sLTx for patients with pulmonary fibrosis (54 ± 9 years, 88 male). Data and outcomes were analyzed retrospectively comparing recipients receiving left sLTX (n = 98) and right sLTx (n = 40).

Survival was 83%, 59%, and 29% at 1, 5, and 10 years for the total patient cohort. Survival was similar for left and right sLTx (83 vs 81%, 58 vs 64%, and 29 vs 28% at 1, 5, and 10 years, p = 0.54). Left and right transplantations lead to similar best post-transplant forced expiratory volume per second (74% ± 20% vs 74% ± 21%, p = 0.86). While the total lung capacity (TLC) ratio TLCdonor/predicted TLCrecipient was similar between groups (104% vs 100%), the ratio TLCdonor/actual TLCrecipient was higher in left sLTx (185% vs 158%, p = 0.04). On multivariate regression analysis, postoperative pneumonia (p = 0.003, hazard ratio 3.404) and sepsis (p = 0.002, hazard ratio 10.700) were identified as predictors for early mortality.

Performing sLTx for pulmonary fibrosis patients can be an effective strategy to optimize donor utilization and improve outcomes—irrespective of graft side.

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