title: Single-lung transplantation in emphysema: Retrospective study analyzing survival and waiting list mortality.
abstract: OBJECTIVE
  To performed remains a subject of debate and is the principal aim of the study.
  
  
  METHODS
  This retrospective analysis included 73 patients with emphysema (2000-2012). The outcomes of patients undergoing single-lung transplantation (SL) (n = 40) or double-lung transplant (DL) (n = 33) were compared in a Cox multivariate analysis to study the impact of the technique, postoperative complications and acute and chronic rejection on survival rates. Patients were selected for inclusion in the waiting list according to the International Society of Heart Lung Transplantation criteria. Pre and postoperative rehabilitation and prophylaxis, surgical technique and immunosuppressive treatment were similar in every patients. Lung transplantation waiting list information on a national level and retrospective data on emphysema patient survival transplanted in Spain during the study period, was obtained from the lung transplantation registry managed by the National Transplant Organization (ONT).
  
  
  RESULTS
  Both groups were comparable in terms of gender and clinical characteristics. We found significant differences in the mean age between the groups, the DL patients being younger as expected from the inclusion criteria. Perioperative complications occurred in 27.6% SL vs 54% DL (P = 0.032). Excluding perioperative mortality, median survival was 65.3 mo for SL and 59.4 mo for DL (P = 0.96). Bronchiolitis obliterans and overall 5-year survival were similar in both groups. Bacterial respiratory infection, cytomegalovirus and fungal infection rates were higher but not significant in SL. No differences were found between type of transplant and survival (P = 0.48). To support our results, national data on all patients with emphysema in waiting list were obtained (n = 1001). Mortality on the waiting list was 2.4% for SL vs 6.2% for DL. There was no difference in 5 year survival between 235 SL and 430 DL patients transplanted (P = 0.875).
  
  
  CONCLUSIONS
  Our results suggest that SL transplantation in emphysema produce similar survival than DL with less postoperative complication and significant lower mortality in waiting list.
authors.affiliation: José M Borro, María Delgado, Department of Thoracic Surgery and Lung Transplantation, Corunna University Hospital, 15006 Corunna, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Borro
authors.affiliation: José M Borro, María Delgado, Department of Thoracic Surgery and Lung Transplantation, Corunna University Hospital, 15006 Corunna, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Delgado
authors.affiliation: José M Borro, María Delgado, Department of Thoracic Surgery and Lung Transplantation, Corunna University Hospital, 15006 Corunna, Spain.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Coll
authors.affiliation: José M Borro, María Delgado, Department of Thoracic Surgery and Lung Transplantation, Corunna University Hospital, 15006 Corunna, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Pita
keywords: Complications; Double-lung; Emphysema; Lung transplantation; Single-lung; Survival