title: What Is the Optimal Transplant for Older Patients With Idiopathic Pulmonary Fibrosis?
abstract: BACKGROUND
  There is controversy regarding the optimal type of lung transplant--single orthotopic lung transplantation (SOLT) versus bilateral orthotopic lung transplantation (BOLT)--for patients with idiopathic pulmonary fibrosis. We performed this study to determine which type of transplant is more appropriate for older patients with this condition.
  
  
  METHODS
  We conducted a review of the United Network for Organ Sharing database from 2005 to 2013 for patients aged 65 years or more with idiopathic pulmonary fibrosis. A 1:1 nearest-neighbor propensity match was utilized to determine differences in survival by transplant procedure type (SOLT versus BOLT). Logistic regression modeling taking into account interaction terms between prespecified variables and the type of transplant was utilized to determine variables that altered the survival outcomes associated with SOLT versus BOLT.
  
  
  RESULTS
  Of 1,564 patients who met study criteria, 521 (33.3%) received BOLT. After propensity matching 498 BOLT recipients to 498 SOLT recipients, BOLT was associated with a significantly improved 5-year survival (48.7% versus 35.2%, p < 0.01). However, the mortality hazard associated with BOLT varied from a nonsignificant reduction in survival within 3 months after transplant (hazard ratio 1.24, 95% confidence interval: 0.80 to 1.93) to a significant survival benefit for patients who survived beyond 1 year (hazard ratio 0.64, 95% confidence interval: 0.47 to 0.86). Functional status was also found to be a significant predictor of the survival benefit associated with BOLT.
  
  
  CONCLUSIONS
  Bilateral orthotopic lung transplantation is associated with significantly improved survival over SOLT for older patients with idiopathic pulmonary fibrosis, driven by a late survival benefit from bilateral transplantation. However, patients with a reduced preoperative functional status do not appear to derive a similar benefit from bilateral transplantation.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Gulack
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Asvin M
authors.initials: AM
authors.lastname: Ganapathi
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: James M
authors.initials: JM
authors.lastname: Meza
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Hirji
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Laurie D
authors.initials: LD
authors.lastname: Snyder
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: R Duane
authors.initials: RD
authors.lastname: Davis
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: matthew.hartwig@duke.edu.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000601:surgery*; D016040:Lung Transplantation / Q000379:methods* / Q000592:standards*; D008297:Male; D012189:Retrospective Studies