title: Staging of Bilateral Lung Transplantation for High-Risk Patients With Interstitial Lung Disease: One Lung at a Time.
abstract: The choice of a single or bilateral lung transplant for interstitial lung disease (ILD) is controversial, as surgical risk, long-term survival and organ allocation are competing factors. In an effort to balance risk and benefit, our center adopted a staged bilateral lung transplant approach for higher surgical risk ILD patients where the patient has a single lung transplant followed by a second single transplant at a later date. We sought to understand the surgical risk, organ allocation and early outcomes of these staged bilateral recipients as a group and in comparison to matched single and bilateral recipients. Our analysis demonstrates that staged bilateral lung transplant recipients (n = 12) have a higher lung allocation score (LAS), lower pulmonary function tests and a lower glomerular filtration rate prior to the first transplant compared to the second (p < 0.01). There was a shorter length of hospital stay for the second transplant (p = 0.02). The staged bilateral compared to the single and bilateral case-matched controls had comparable short-term survival (p = 0.20) and pulmonary function tests at 1 year. There was a higher incidence of renal injury in the conventional bilateral group compared to the single and staged bilateral groups. The staged bilateral procedure is a viable option in select ILD patients.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC. matthew.hartwig@duke.edu.
authors.forename: M G
authors.initials: MG
authors.lastname: Hartwig
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: A M
authors.initials: AM
authors.lastname: Ganapathi
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: A A
authors.initials: AA
authors.lastname: Osho
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: S A
authors.initials: SA
authors.lastname: Hirji
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: B R
authors.initials: BR
authors.lastname: Englum
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: P J
authors.initials: PJ
authors.lastname: Speicher
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: S M
authors.initials: SM
authors.lastname: Palmer
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: R D
authors.initials: RD
authors.lastname: Davis
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: L D
authors.initials: LD
authors.lastname: Snyder
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D017563:Lung Diseases, Interstitial / Q000401:mortality* / Q000601:surgery; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors
keywords: clinical research/practice; lung transplantation/pulmonology; organ allocation; organ procurement and allocation; waitlist management