PURPOSE: There is a recent trend towards performing more bilateral lung transplants (BLT) for COPD. However, there is a substantial number of patients who clinically do very well with a SLT with survival rates comparable to those undergoing BLT. We sought to examine this observation by analyzing multicenter data on survival following SLT for COPD.
METHODS: Patients with diagnosis of COPD or alpha-1-ATD who underwent SLT between January 1, 2000 and December 31, 2005 at four transplant centers were studied. The IRB of each of the institutions approved the protocol. Patients were included if they had an uncomplicated post operative period, were discharged home and survived at least three months post SLT. The primary outcome was the best percentage predicted FEV1 within the first year post transplant and its effect on survival. After obtaining authorization, we used data from the International Society for Heart and Lung Transplantation (IHSLT) registry from January 2000 to June 2004 for patients undergoing SLT or BLT for COPD as a reference for survival curves with a conditional three month survival.
RESULTS: A total of 190 patients were studied (mean age 59.5±5.5 years, 50% female, mean pre-transplant FEV1 0.6L ± 0.3L). Survival was significantly improved among those with best predicted post-transplant FEV1 ≥ 65% at 5 years (65.1% vs 56.7%, p=0.03) and at 3 years (75.8% vs 65.3%, p=0.008). The long term survival rates in patient with FEV1 ≥ 65% within the first post transplant year are comparable to those receiving BLT for COPD during the same era as reported to the ISHLT (Fig.1).
CONCLUSION: Single lung transplants for COPD achieving a best FEV1 ≥ 65% within the first year post-transplant have better long term survival rates as compared to those patients with FEV1 < 65% and comparable to those undergoing BLT.
CLINICAL IMPLICATIONS: Lung transplant recipients with COPD having best FEV1 ≥ 65% have similar long term survival with single and bilateral lung transplantation.
DISCLOSURE: Luis Angel, None.