title: Survival after bilateral versus single-lung transplantation for idiopathic pulmonary fibrosis.
abstract: 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.
authors: Hôpital Bichat, APHP et Université Paris-Diderot Paris-7, INSERM U738, INSERM U717, Paris, France. gabriel.thabut@bch.aphp.fr
authors: Gabriel
authors: G
authors: Thabut
authors: Jason D
authors: JD
authors: Christie
authors: Philippe
authors: P
authors: Ravaud
authors: Yves
authors: Y
authors: Castier
authors: Gaëlle
authors: G
authors: Dauriat
authors: Gilles
authors: G
authors: Jebrak
authors: Michel
authors: M
authors: Fournier
authors: Guy
authors: G
authors: Lesèche
authors: Raphaël
authors: R
authors: Porcher
authors: Hervé
authors: H
authors: Mal
mesh_terms: 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