Controversies in Lung Transplantation: Are Two Lungs Better Than One?

ABSTRACT

Lung transplantation is commonly used for patients with end-stage lung disease. However, there is continuing debate on the optimal operation for patients with chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis. Single-lung transplantation (SLT) provides equivalent short- and medium-term results compared with bilateral lung transplantation (BLT), but long-term survival appears slightly better in BLT recipients (especially in patients with COPD). The number of available organs for lung transplantation also influences the choice of operation. Recent developments suggest that the organ donor shortage is not as severe as previously thought, making BLT a possible alternative for more patients. Local expertise and waiting list issues are important in influencing the choice of SLT versus BLT. Most of the data support the use of BLT for the majority of COPD patients when available, and the use of SLT for the majority of idiopathic pulmonary fibrosis (IPF) patients. The ultimate choice of operation will depend on donor and recipient characteristics and local expertise and waiting list issues.

KEYWORDS

Lung transplantation - chronic obstructive pulmonary disease - idiopathic pulmonary fibrosis

REFERENCES

• 1 Trulock E P, Edwards L B, Taylor D O, Boucek M M, Keck B M, Hertz M I. Registry of the International Society for Heart and Lung Transplantation: twenty-second official adult lung and heart-lung transplant report-2005.  J Heart Lung Transplant. 2005;  24 956-967
• 2 Pierson III R N, Barr M L, McCullough K P et al.. Thoracic organ transplantation.  Am J Transplant. 2004;  4(Suppl 9) 93-105
• 3 Meyers B F, Lynch J P, Trulock E P, Guthrie T, Cooper J D, Patterson G A. Single versus bilateral lung transplantation for idiopathic pulmonary fibrosis: a ten-year institutional experience.  J Thorac Cardiovasc Surg. 2000;  120 99-107
• 4 Pochettino A, Kotloff R M, Rosengard B R et al.. Bilateral versus single lung transplantation for chronic obstructive pulmonary disease: intermediate-term results.  Ann Thorac Surg. 2000;  70 1813-1818 discussion 1818-1819
• 5 Sundaresan R S, Shiraishi Y, Trulock E P et al.. Single or bilateral lung transplantation for emphysema?.  J Thorac Cardiovasc Surg. 1996;  112 1485-1494 discussion 1494-1495
• 6 Meyer D M, Edwards L B, Torres F, Jessen M E, Novick R J. Impact of recipient age and procedure type on survival after lung transplantation for pulmonary fibrosis.  Ann Thorac Surg. 2005;  79 950-957 discussion 957-958
• 7 Hadjiliadis D, Chaparro C, Messier R H et al.. Impact of lung transplant operation on bronchiolitis obliterans syndrome (BOS) in patients with idiopathic pulmonary fibrosis (IPF) [abstract].  Am J Transplant. 2003;  5S A695
• 8 Whelan T PM, Dunitz J M, Kelly R F et al.. Effect of preoperative pulmonary artery pressure on early survival after lung transplantation for idiopathic pulmonary fibrosis.  J Heart Lung Transplant. 2005;  24 1269-1274
• 9 Palmer S M, Davis R D, Simsir S A et al.. Successful bilateral lung transplant outcomes in recipients 61 years of age and older.  Transplantation. 2006;  81 862-865
• 10 Hosenpud J D, Bennett L E, Keck B M, Edwards E B, Novick R J. Effect of diagnosis on survival benefit of lung transplantation for end-stage lung disease.  Lancet. 1998;  351 24-27
• 11 De Meester J, Smits J M, Persijn G G, Haverich A. Listing for lung transplantation: life expectancy and transplant effect, stratified by type of end-stage lung disease, the Eurotransplant experience.  J Heart Lung Transplant. 2001;  20 518-524
• 12 Charman S C, Sharples L D, McNeil K D, Wallwork J. Assessment of survival benefit after lung transplantation by patient diagnosis.  J Heart Lung Transplant. 2002;  21 226-232
• 13 Meyer D M, Bennett L E, Novick R J, Hosenpud J D. Single vs bilateral, sequential lung transplantation for end-stage emphysema: influence of recipient age on survival and secondary end-points.  J Heart Lung Transplant. 2001;  20 935-941
• 14 Cassivi S D, Meyers B F, Battafarano R J et al.. Thirteen-year experience in lung transplantation for emphysema.  Ann Thorac Surg. 2002;  74 1663-1669 discussion 1669-1670
• 15 Hadjiliadis D, Chaparro C, Gutierrez C et al.. Impact of lung transplant operation on bronchiolitis obliterans syndrome in patients with chronic obstructive pulmonary disease.  Am J Transplant. 2006;  6 183-189
• 16 Weill D, Torres F, Hodges T N, Olmos J J, Zamora M R. Acute native lung hyperinflation is not associated with poor outcomes after single lung transplant for emphysema.  J Heart Lung Transplant. 1999;  18 1080-1087
• 17 Malchow S C, McAdams H P, Palmer S M, Tapson V F, Putman C E. Does hyperexpansion of the native lung adversely affect outcome after single lung transplantation for emphysema? Preliminary findings.  Acad Radiol. 1998;  5 688-693
• 18 Venuta F, Boehler A, Rendina E A et al.. Complications in the native lung after single lung transplantation.  Eur J Cardiothorac Surg. 1999;  16 54-58
• 19 Moy M L, Loring S H, Ingenito E P, Mentzer S J, Reilly Jr J J. Causes of allograft dysfunction after single lung transplantation for emphysema: extrinsic restriction versus intrinsic obstruction. Brigham and Women's Hospital Lung Transplantation Group.  J Heart Lung Transplant. 1999;  18 986-993
• 20 Mal H, Brugiere O, Sleiman C et al.. Morbidity and mortality related to the native lung in single lung transplantation for emphysema.  J Heart Lung Transplant. 2000;  19 220-223
• 21 McAdams H P, Erasmus J J, Palmer S M. Complications (excluding hyperinflation) involving the native lung after single-lung transplantation: incidence, radiologic features, and clinical importance.  Radiology. 2001;  218 233-241
• 22 Collins J, Kazerooni E A, Lacomis J et al.. Bronchogenic carcinoma after lung transplantation: frequency, clinical characteristics, and imaging findings.  Radiology. 2002;  224 131-138
• 23 Barr M L, Kawut S M, Whelan T P et al.. Report of the ISHLT working group on primary lung graft dysfunction, IV: Recipient-related risk factors and markers.  J Heart Lung Transplant. 2005;  24 1468-1482
• 24 Anyanwu A C, McGuire A, Rogers C A, Murday A J. Assessment of quality of life in lung transplantation using a simple generic tool.  Thorax. 2001;  56 218-222
• 25 Gerbase M W, Spiliopoulos A, Rochat T, Archinard M, Nicod L P. Health-related quality of life following single or bilateral lung transplantation: a 7-year comparison to functional outcome.  Chest. 2005;  128 1371-1378
• 26 National Data on Lung Transplantation .United Network of Organ Sharing. Data reports. Available at http://www.unos.org Accessed July 20th, 2006
• 27 Organ distribution: allocation of thoracic organs. United Network of Organ Sharing. Available at http://www.unos.org Accessed July 20th, 2006
• 28 National Data on Lung Transplantation .United Network of Organ Sharing. Data reports. Available at http://www.unos.org Accessed June 16th, 2006
• 29 Hadjiliadis D, Ahya V N, Christie J D, Sager J S, Pocchettino A, Kotloff R M. Early results of lung transplantation after implementation of the new lung allocation score.  J Heart Lung Transplant. 2006;  25 1167-1170
• 30 Angel L F, Levine D J, Restrepo M I et al.. Impact of a lung transplantation donor-management protocol on lung donation and recipient outcomes.  Am J Respir Crit Care Med. 2006;  , online early June 23, 2006 as doi: 10.1164/rccm.200603-432OC
• 31 Bhorade S M, Vigneswaran W, McCabe M A, Garrity E R. Liberalization of donor criteria may expand the donor pool without adverse consequence in lung transplantation.  J Heart Lung Transplant. 2000;  19 1199-1204
• 32 Pierre A F, Sekine Y, Hutcheon M A, Waddell T K, Keshavjee S H. Marginal donor lungs: a reassessment.  J Thorac Cardiovasc Surg. 2002;  123 421-427 discussion 427-428