Comparing Outcomes of Single versus Double Lung Transplantation for COPD Patients in a Single-Center Setting

Abstract

<h3>Purpose</h3> There is conflicting data whether single (SLT) or double (DLT) lung transplant is preferred for end-stage chronic obstructive pulmonary disease (COPD) patients. While national data shows that DLT is the method of choice, it is important re-assess this stance considering the current national organ shortage. The purpose of this study is to investigate whether SLT patients perform similarly to DLT patients in a single center setting. <h3>Methods</h3> We retrospectively identified COPD patients who underwent lung transplantation from 02/2012-05/2021 at our center (n=228). Clinical parameters were compared between the patients based on the type of transplant. Survival outcomes between the cohorts were compared using Kaplan Meier, as well as Cox proportional hazard regression. P-value <0.05 was significant. <h3>Results</h3> Of the 228 COPD patients, 81 (35.5%) received DLTs and 147 (64.5%) received SLTs. The difference in survival outcomes between patients receiving SLTs and DLTs was not significant (P = 0.265). The Cox model also did not show a significant difference in survival (P = 0.298). There was no significance in the distribution of transplant type by recipient body mass index, serum creatinine, serum albumin, or forced expiration volume at time of transplant. There was significance in the distribution of transplant type by recipient age (P = 0.017), recipient sex (P<0.001), recipient race (P = 0.049), lung allocation score (P<0.001), recipient height (P<0.001), mean pulmonary artery pressure (P = 0.002), surgical approach (P<0.001), induction (P = 0.043), donor sex (P = 0.030), donor height (P = 0.005), length of stay (P = 0.008), and forced vital capacity at transplant (P = 0.014). Patient age was the only variable to affect survival (HR = 5.60; P = 0.048). <h3>Conclusion</h3> Patients who received SLTs at our center did not show a significant difference in survival outcomes when compared to patients who received DLTs. This could suggest that SLT's may be the preferred method bearing in mind the current organ shortage.