Surgical patient outcomes after the increased use of bilateral lung transplantation.
OBJECTIVE
Despite the potential limitation of organ availability, several surgical groups have advocated preferential bilateral lung transplantation because of its demonstrated long-term survival advantage. Comparative results for single and sequential double lung transplantation performed at a single center are evaluated to determine whether such a policy improves patient outcome.


METHODS
A retrospective analysis of demographic and outcome data for patients undergoing lung transplantation was performed. Patients were grouped as single or double lung recipients and segregated into diagnostic categories according to the lung allocation scoring system. Era terciles were chosen on the basis of year of transplant, operating surgeon, and transplant volume.


RESULTS
Between November 1990 and September 2005, 344 lung transplant procedures were performed in 339 patients. Over three time periods evaluated, the proportion of patients undergoing double lung transplant procedures increased. Overall survivals at 3 months and 1, 3, and 5 years were 89%, 79%, 60%, and 52%, respectively. After adjusting for lung recipient characteristics, survival after double lung transplantation was improved when compared with single lung transplantation (P = .020). Overall patient survival among the three time periods was not significantly different at 30 days and 1 and 3 years despite increasing maximal donor organ ischemia times.


CONCLUSIONS
In this single-center study, despite longer median allograft ischemic times, as well as greater patient acuity as determined by listing diagnosis, overall early and midterm patient survival has remained higher than nationally reported figures. Bilateral lung transplantation in eligible patients is the procedure of choice.
Chang
Andrew C
AC
Section of Thoracic Surgery, University of Michigan Health System, Ann Arbor, Mich 48109, USA. andrwchg@umich.edu
Chan
Kevin M
KM
Lonigro
Robert J
RJ
Lau
Christine L
CL
Lama
Vibha N
VN
Flaherty
Kevin R
KR
Florn
Ros
R
Pickens
Allan
A
Murray
Susan
S
Martinez
Fernando J
FJ
Orringer
Mark B
MB
D000328:Adult; D016001:Confidence Intervals; D046148:Donor Selection; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008171:Lung Diseases / Q000473:pathology / Q000601:surgery*; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods; D016896:Treatment Outcome; D014850:Waiting Lists