Lung transplantation as the first choice in emphysema.
BACKGROUND
The indication for single or double lung transplantation in patients diagnosed with pulmonary emphysema is a topic of current debate. Our aim was to analyze the differences in the incidence of perioperative complications, survival, and quality of life between single and double lung transplantations.


METHODS
From 1999 to 2008, 223 subjects underwent transplantation in our department, of whom 62 (28%) had a previous diagnosis of pulmonary emphysema. A retrospective study was performed to establish possible differences between group 1 (single lung) and group 2 (double lung) transplants analyzing overall survival using the Kaplan-Meier method and differences between groups using the log-rank test. Pearson chi-square test was used to compare the frequency of postoperative complications, bronchiolitis obliterans BOS acute rejection episodes, and infections.


RESULTS
We included 62 patients who underwent transplantation for emphysema. Cumulative 5-year survival rate, excluding preoperative mortality, was 54% overall, 59% for group 1, and 56% for group 2. No significant differences were observed between the groups (P = .47). The frequency of BOS was 34% in group 1 and 42% in group 2 (P = .52). At least 1 acute rejection episode occurred in 52% of group 1 patients and 51% of group 2 patients (P = .98). Bacterial infections were experienced by 50% of group 1 patients and 54% of group 2 patients (P = .72). Fungal infections affected 10% of group 1 patients and 15% of group 2 patients (P = .71). Intraoperative complications were recorded in 27.6% of group 1 patients versus 54% of group 2 patients, a difference that was statistically significant (P = .032).


CONCLUSIONS
The study results supported the decision of our group to consider single lung transplantation the treatment of choice in emphysema, which may be complemented with volume reduction surgery in the native lung or subsequent transplantation of the contralateral lung.
Delgado
M
M
Departament of Thoracic Surgery and Lung Transplantation, University Hospital A Coruña, A Coruña, Spain. mtorre@canalejo.org
Borro
J M
JM
De La Torre
M M
MM
Fernández
R
R
González
D
D
Paradela
M
M
García
J A
JA
Fieira
E
E
Rama
P
P
D000704:Analysis of Variance; D001989:Bronchiolitis Obliterans / Q000453:epidemiology; D007839:Functional Laterality; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects / Q000276:immunology / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology; D011656:Pulmonary Emphysema / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors
D007166:Immunosuppressive Agents