Title: Single-lung transplantation: does side matter?
Authors: Tsagkaropoulos, Sokratis ×
Belmans, Ann
Verleden, Geert
Coosemans, Willy
Decaluwé, Herbert
De Leyn, Paul
Nafteux, Philippe
Van Raemdonck, Dirk #
Issue Date: Aug-2011
Publisher: Elsevier Science
Series Title: European Journal of Cardio-Thoracic Surgery vol:40 issue:2 pages:E83-E92
Conference: 18th European Conference on General Thoracic Surgery of the European-Society-of-Thoracic-Surgeons Valladolid, SPAIN, MAY 30-JUN 02, 2010
Abstract: Objective: Single-lung transplantation (SLTx) is a valid treatment option for patients with non-suppurative end-stage pulmonary disease. This strategy helps to overcome current organ shortage. Side is usually chosen based on pre-transplant quantitative perfusion scan, unless specific recipient considerations or contralateral lung offer dictates opposite side. It remains largely unknown whether outcome differs between left (L) versus right (R) SLTx. Methods: Between July 1991 and July 2009, 142 first SLTx (M/F = 87/55; age = 59 (29-69) years) were performed from 142 deceased donors (M/F = 81/61; age = 40 (14-66) years) with a median follow-up of 32 (0-202) months. Indications for SLTx were emphysema (55.6%), pulmonary fibrosis (36.6%), primary pulmonary hypertension (0.7%), and others (7.0%). Recipients of L-SLTx (n = 72) and R-SLTx (n = 70) were compared for donor and recipient characteristics and for early and late outcome. Results: Donors of L-SLTx were younger (37 (14-65) vs 43 (16-66) years; p = 0.033). R-SLTx recipients had more often emphysema (67.1% vs 44.4%; p = 0.046) and replacement of native lung with >= 50% perfusion (47.1% vs 23.6%; p = 0.003). The need for bypass, time to extubation, intensive care unit (ICU) and hospital stay, and 30-day mortality did not differ between groups. Overall survival at 1, 3, and 5 years was 78.4%, 60.5%, and 49.4%, respectively, with a median survival of 60 months, with no significant differences between sides. Forced expiratory volume in 1 s (FEV1) improved (p < 0.01) in both groups to comparable values up to 36 months. Complications overall (44.4% vs 50.0%) or in allograft (25.0% vs 24.3.0%) as well as time to bronchiolitis obliterans syndrome (BOS) (35 months) and 5-year freedom from BOS (68.9% vs 75.0%) were comparable after L-SLTx versus R-SLTx, respectively. There were no differences in all causes of death (p = 0.766). On multivariate analysis, BOS was a strong negative predictor for survival (hazard ratio (HR) 6.78; p < 0.001), whereas side and mismatch for perfusion were not. Conclusion: The preferred side for SLTx differed between fibrotic versus emphysema recipients. Transplant side does not influence recipient survival, freedom from BOS, complications, or pulmonary function after SLTx. Besides surgical considerations in the recipient, offer of a donor lung opposite to the preferred side should not be a reason to postpone the transplantation until a better-matched donor is found. (C) 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
ISSN: 1010-7940
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Thoracic Surgery
Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat)
Laboratory of Abdominal Transplantation
× corresponding author
# (joint) last author

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