Single lung transplantation (SLT) is the accepted transplant procedure of choice for patients with idiopathic pulmonary fibrosis (IPF). Despite this approximately 1/3 of IPF transplant recipients received bilateral/double lung transplants (BLT). Recent data does attest to a long-term survival benefit of the latter procedure over the former in lung transplant patients, specifically the COPD subgroup. However, there is a paucity of data looking at the survival differences between the two procedures in the IPF subgroup.
Based on Organ Procurement and Transplant Network data as of March 7, 2003, we performed a retrospective analysis of the UNOS database looking at all patients with IPF transplanted between 1989 and 2000. Patients were categorized as to whether they received bilateral or single lung transplants. Demographic data between the two groups was compared. This included age, gender, ethnicity, waiting time on the list, steroid dependence, PFT data and the presence of pulmonary sepsis. Actuarial survival curves were generated for both groups.
There were a total of 1,089 transplants between 1989 and 2000. Of these, 863 were single lung transplants and 226 were bilateral lungs. Comparison of patient demographics is shown in Table 1DoubleSinglep valueAge (median, range)48 (1–65)55 (1–73)0.001Gender (male/female %)62/3863.5/36.50.67Treat for sepis (% yes)6.42.80.08Chronic steroid Use (% yes)64.063.80.56. Actuarial survivals at one through five years are shown in Table 2DoubleSingleYearSurvival95% CISurvival95% CI16357–696865–7125548–615956–6235043–565147–5444437–514137–4454033–473632–40.
There is no survival advantage conferred by bilateral over single lung transplant in IPF patients. Patients who received BLTs were significantly younger, but otherwise there were no significant differences in demographic profiles, forced vital capacity, or incidence of pulmonary sepsis between the two groups. Therefore the reason for the relatively high proportion of bilateral lung transplants in this group of patients remains unclear.
Single lung transplantation remains the procedure of choice in IPF patients. Avoidance of the bilateral procedure in these patients may allow more patients to be transplanted.
S.D. Barnett, None.