title: Continued Utility of Single-Lung Transplantation in Select Populations: Chronic Obstructive Pulmonary Disease.
abstract: BACKGROUND
  The use of single lung transplantation (SLTx) for chronic obstructive pulmonary disease is often viewed as inferior therapy compared with bilateral lung transplantation (BLTx). We hypothesized from our experience that subpopulations of recipients with emphysema exist in which SLTx represents therapy that is equivalent to BLTx, therefore allowing more patients access to transplantation.
  
  
  METHODS
  Consecutive patients undergoing LTx for emphysema between 1992 and 2012 at a single institution were identified and analyzed retrospectively. A similar cohort from the United Network of Organ Sharing (UNOS) national database was identified for comparison. Five-year survival in patients receiving SLTx and those receiving BLTx were compared using Kaplan-Meier survival curves and log-rank tests.
  
  
  RESULTS
  Two hundred thirty-six patients meeting criteria were identified from our institution. Two hundred six underwent SLTx, and 30 underwent BLTx. Five-year survival for single-center SLTx (53.2% ± 3.6%) and BLTx (56.7% ± 10.2%) was not significantly different (p = 0.753). The national database included 7,256 patients meeting selection criteria, with 4,408 undergoing SLTx and 2,848 undergoing BLTx. Five-year survival among the national cohorts was lower for SLTx (46.4% ± 0.8%) compared with BLTx (55.9% ± 1.1%) (p < 0.0001). However, 5-year survival for our single-center SLTx experience (53.2% ± 3.6%) was comparable to the national BLTx cohort (55.9% ± 1.1%) (p = 0.539).
  
  
  CONCLUSIONS
  Five-year survival after SLTx for emphysema was comparable to that for BLTx in cohorts from our institution and from the UNOS national database. Further study should focus on the mechanism behind these improved outcomes. Given the potential for a larger number of life-years saved, SLTx should continue to be considered a therapeutic option in appropriately selected patients with chronic obstructive pulmonary disease (COPD).
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Daine T
authors.initials: DT
authors.lastname: Bennett
authors.affiliation: Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Martin
authors.initials: M
authors.lastname: Zamora
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: T Brett
authors.initials: TB
authors.lastname: Reece
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: John D
authors.initials: JD
authors.lastname: Mitchell
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Cleveland
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Ashok N
authors.initials: AN
authors.lastname: Babu
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Meguid
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
authors.forename: David A
authors.initials: DA
authors.lastname: Fullerton
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado. Electronic address: michael.weyant@ucdenver.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Weyant
mesh_terms: D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000601:surgery*; D011656:Pulmonary Emphysema / Q000401:mortality* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors