title: Bilateral lung transplantation offers better long-term survival, compared with single-lung transplantation, for younger patients with idiopathic pulmonary fibrosis.
abstract: BACKGROUND
  Single-lung transplantation (SLT) and bilateral lung transplantation (BLT) are both good options for patients with end-stage lung disease secondary to idiopathic pulmonary fibrosis. It is, however, unclear whether BLT offers any survival advantage over SLT. The purpose of our study was to evaluate a large group of patients to determine if either SLT or BLT officered a long-term survival advantage for patients with IPF.
  
  
  METHODS
  This was an Institutional Review Board-approved retrospective analysis of the United Network of Organ Sharing database from 1987 to 2008. Survival was determined using Kaplan-Meir estimates and the effect of laterality was determined by Cox proportional hazards and propensity analyses.
  
  
  RESULTS
  Lung transplantation for idiopathic pulmonary fibrosis was performed in 3,860 patients (2,431 SLTs and 1429 BLTs). Multivariate and propensity analysis failed to show any survival advantage for BLT (hazard ratio = 0.90, 95% confidence interval = 0.78 to 1.0, p = 0.11). One-year conditional survival favored BLT (hazard ratio 0.73, 95% confidence interval 0.60 to 0.87, p = 0.00064). Risk factors for early death included recipient age over 57 and donor age over 36 years.
  
  
  CONCLUSIONS
  Bilateral lung transplantation should be considered for younger patients with idiopathic pulmonary fibrosis and results may be optimized when younger donors are used.
authors.affiliation: Department Surgery, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA. sforce@emory.edu
authors.forename: Seth D
authors.initials: SD
authors.lastname: Force
authors.forename: Pat
authors.initials: P
authors.lastname: Kilgo
authors.forename: David C
authors.initials: DC
authors.lastname: Neujahr
authors.forename: Andres
authors.initials: A
authors.lastname: Pelaez
authors.forename: Allan
authors.initials: A
authors.lastname: Pickens
authors.forename: Felix G
authors.initials: FG
authors.lastname: Fernandez
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Miller
authors.forename: Clint
authors.initials: C
authors.lastname: Lawrence
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult