title: Twinned single-lung transplantation: a privileged model for the study of recipient-dependent factors of outcome.
abstract: OBJECTIVE
  Lung transplantation is the only life-saving treatment for end-stage respiratory disease. The outcome will depend on the graft quality, surgical conditions and recipient factors. Twinned single-lung transplantation defines as two different recipients treated with lung grafts from the same donor. Recipient-dependent factors of the outcome can be studied more accurately as the graft quality is supposed equal for both recipients.
  
  
  METHODS
  We reviewed all single-lung transplantations performed in France between 1998 and 2008 in the French registry run by the 'Agence de Biomédecine'. Criteria for donor lung quality and twinned recipient data were recorded in a database. The whole medical history and the transplantation outcome were reviewed for each patient and compared with its twin recipient. We compared twins on the basis of their opposed characteristics and on the basis of the opposed endpoint outcome. Endpoints were primary graft dysfunction (PGD) grade III, and mortality at 1, 3 and 12 months.
  
  
  RESULTS
  A total of 387 single-lung transplantations were performed in 10 French centres; 180 were twinned recipients from 90 donors. Statistical analysis revealed a significantly different outcome for PGD only. PGD was significantly higher (P < 0.05) in fibrosis recipients compared with emphysema twins. In 28 pairs (31%), the outcome was discordant for PGD, and fibrosis was significantly more often involved compared with emphysema (P = 0.04). Sixty-two pairs had a similar outcome: two pairs showed PGD in both recipients while 60 pairs were free of PGD.
  
  
  CONCLUSIONS
  We conclude that recipient's disease is a major determinant of the outcome. Fibrosis is associated with an increased risk for PGD.
authors.affiliation: Lung Transplantation Group, University Hospital Strasbourg, Strasbourg, France. brendanne@free.fr
authors.forename: Anne
authors.initials: A
authors.lastname: Olland
authors.forename: Nicola
authors.initials: N
authors.lastname: Santelmo
authors.forename: Bastien
authors.initials: B
authors.lastname: Orsini
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Falcoz
authors.forename: Richard
authors.initials: R
authors.lastname: Dorent
authors.forename: Hervé
authors.initials: H
authors.lastname: Mal
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
authors.forename: Gilbert
authors.initials: G
authors.lastname: Massard
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D055031:Primary Graft Dysfunction / Q000209:etiology*; D011379:Prognosis; D011656:Pulmonary Emphysema / Q000401:mortality / Q000601:surgery; D011658:Pulmonary Fibrosis / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome