title: Single-lung transplantation: does side matter?
abstract: OBJECTIVE
  Single-lung transplantation (SLTx) is a valid treatment option for patients with non-suppurative end-stage pulmonary disease. This strategy helps to overcome current organ shortage. Side is usually chosen based on pre-transplant quantitative perfusion scan, unless specific recipient considerations or contralateral lung offer dictates opposite side. It remains largely unknown whether outcome differs between left (L) versus right (R) SLTx.
  
  
  METHODS
  Between July 1991 and July 2009, 142 first SLTx (M/F=87/55; age=59 (29-69) years) were performed from 142 deceased donors (M/F=81/61; age=40 (14-66) years) with a median follow-up of 32 (0-202) months. Indications for SLTx were emphysema (55.6%), pulmonary fibrosis (36.6%), primary pulmonary hypertension (0.7%), and others (7.0%). Recipients of L-SLTx (n=72) and R-SLTx (n=70) were compared for donor and recipient characteristics and for early and late outcome.
  
  
  RESULTS
  Donors of L-SLTx were younger (37 (14-65) vs 43 (16-66) years; p=0.033). R-SLTx recipients had more often emphysema (67.1% vs 44.4%; p=0.046) and replacement of native lung with ≥ 50% perfusion (47.1% vs 23.6%; p=0.003). The need for bypass, time to extubation, intensive care unit (ICU) and hospital stay, and 30-day mortality did not differ between groups. Overall survival at 1, 3, and 5 years was 78.4%, 60.5%, and 49.4%, respectively, with a median survival of 60 months, with no significant differences between sides. Forced expiratory volume in 1s (FEV₁) improved (p<0.01) in both groups to comparable values up to 36 months. Complications overall (44.4% vs 50.0%) or in allograft (25.0% vs 24.3.0%) as well as time to bronchiolitis obliterans syndrome (BOS) (35 months) and 5-year freedom from BOS (68.9% vs 75.0%) were comparable after L-SLTx versus R-SLTx, respectively. There were no differences in all causes of death (p=0.766). On multivariate analysis, BOS was a strong negative predictor for survival (hazard ratio (HR) 6.78; p<0.001), whereas side and mismatch for perfusion were not.
  
  
  CONCLUSIONS
  The preferred side for SLTx differed between fibrotic versus emphysema recipients. Transplant side does not influence recipient survival, freedom from BOS, complications, or pulmonary function after SLTx. Besides surgical considerations in the recipient, offer of a donor lung opposite to the preferred side should not be a reason to postpone the transplantation until a better-matched donor is found.
authors.affiliation: Department of Thoracic Surgery, University La Sapienza Rome, Rome, Italy.
authors.forename: Sokratis
authors.initials: S
authors.lastname: Tsagkaropoulos
authors.forename: Ann
authors.initials: A
authors.lastname: Belmans
authors.forename: Geert M
authors.initials: GM
authors.lastname: Verleden
authors.forename: Willy
authors.initials: W
authors.lastname: Coosemans
authors.forename: Herbert
authors.initials: H
authors.lastname: Decaluwe
authors.forename: Paul
authors.initials: P
authors.lastname: De Leyn
authors.forename: Philippe
authors.initials: P
authors.lastname: Nafteux
authors.forename: Dirk
authors.initials: D
authors.lastname: Van Raemdonck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001989:Bronchiolitis Obliterans / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008171:Lung Diseases / Q000503:physiopathology / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery; D011658:Pulmonary Fibrosis / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D014019:Tissue Donors; D014109:Total Lung Capacity / Q000502:physiology; D016896:Treatment Outcome; D055815:Young Adult