Survival after bilateral versus single-lung transplantation for idiopathic pulmonary fibrosis.
BACKGROUND
Patients with end-stage idiopathic pulmonary fibrosis (IPF) are increasingly having bilateral rather than single-lung transplantation.


OBJECTIVE
To compare survival after single and bilateral lung transplantation in patients with IPF.


METHODS
Analysis of data from the United Network of Organ Sharing registry.


METHODS
Transplantation centers in the United States.


METHODS
3327 patients with IPF who had single (2146 patients [64.5%]) or bilateral (1181 patients [35.5%]) lung transplantation between 1987 and 2009.


METHODS
Survival times and causes of death after lung transplantation. Selection bias was accounted for by multivariate risk adjustment, propensity score risk adjustment, and propensity-based matching.


RESULTS
Median survival time was longer after bilateral lung transplantation than single-lung transplantation (5.2 years [CI, 4.3 to 6.7 years] vs. 3.8 years [CI, 3.6 to 4.1 years]; P < 0.001). However, survival times for the 2 procedures did not differ after adjustment for baseline differences, with adjusted hazard ratios (HRs) for mortality with bilateral transplantation ranging from 0.89 (95% CI, 0.79 to 1.02) to 0.96 (CI, 0.77 to 1.20) in different analyses. Bilateral lung transplantation seemed to result in harm within the first year (HR, 1.18 [CI, 0.98 to 1.42]) but survival benefit thereafter (HR, 0.72 [CI, 0.59 to 0.87]). Primary graft failure was a more common cause of death among patients who had bilateral rather than single-lung transplantation (3.7% vs. 1.9%; P = 0.002). Cancer was a more common cause of death among patients who had single rather than bilateral lung transplantation (unadjusted HR for death among single vs. bilateral transplant recipients, 3.60 [CI, 2.16 to 6.05]; P <0.001).


CONCLUSIONS
Causes of death were ascertained without an adjudication committee and must be interpreted cautiously.


CONCLUSIONS
Survival did not differ between patients who had single and bilateral lung transplantation. Single-lung transplantation confers short-term survival benefit but long-term harm, whereas bilateral transplantation confers short-term harm but long-term survival benefit.


BACKGROUND
None.
Thabut
Gabriel
G
Hôpital Bichat, APHP et Université Paris-Diderot Paris-7, INSERM U738, INSERM U717, Paris, France. gabriel.thabut@bch.aphp.fr
Christie
Jason D
JD
Ravaud
Philippe
P
Castier
Yves
Y
Dauriat
Gaëlle
G
Jebrak
Gilles
G
Fournier
Michel
M
Lesèche
Guy
G
Porcher
Raphaël
R
Mal
Hervé
H
D002423:Cause of Death; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D020379:Risk Adjustment; D014481:United States / Q000453:epidemiology