HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Joel D. Cooper Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sundaresan, R. S. Articles by Patterson, G. A. Search for Related Content PubMed PubMed Citation Articles by Sundaresan, R. S. Articles by Patterson, G. A.

J Thorac Cardiovasc Surg 1996;112:1485-1495
© 1996 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

CARDIAC AND PULMONARY REPLACEMENT
SINGLE OR BILATERAL LUNG TRANSPLANTATION FOR EMPHYSEMA?

Received for publication May 6, 1996 Revisions requested June 3, 1996; revisions received July 12, 1996 Accepted for publication July 15, 1996. Address for reprints: Sudhir Sundaresan, MD, Division of Cardiothoracic Surgery, Suite 3107 Queeny Tower, One Barnes Hospital Plaza, St. Louis, MO 63110.

Abstract

Background: Most programs favor single lung transplantation for emphysema. However, this is controversial, and we have favored bilateral lung transplantation, confining single lung transplantation mainly to use in older patients and those of small stature.
Methods: A retrospective analysis was done of 119 consecutive lung transplantation procedures for emphysema at Barnes Hospital between 1989 and 1994 (50 single lung, 69 bilateral lung transplants) to (1) identify outcome differences between the two groups and (2) define the appropriate role of these two procedures.
Results: The single lung transplantation group was older and had a higher proportion of female patients. However, baseline pulmonary function (forced expiratory volume in 1 second), arterial oxygen tension, and exercise tolerance (6-minute walk distance) were similar. After transplantation, 90-day mortality (single lung transplantation 10% versus bilateral lung transplantation 7.2%; p = 0.74) and duration of mechanical ventilation, intensive care unit stay, and hospitalization were similar. Both groups achieved a significant and sustained improvement in forced expiratory volume, arterial carbon dioxide tension, arterial oxygen tension, and exercise tolerance within 3 months. However, the improvements in forced expiratory volume, arterial oxygen tension, and exercise tolerance were consistently significantly better in recipients of bilateral transplants at and beyond 6 months. Obliterative bronchiolitis was equally prevalent in both groups. Survival was similar but showed a trend toward better late survival in recipients of bilateral transplants (5-year actuarial survival: bilateral lung transplantation 53% versus single lung transplantation 41%).
Conclusions: We conclude that (1) both procedures are satisfactory options in emphysema, producing durable results; (2) bilateral lung transplantation is not associated with increased operative mortality or morbidity and achieves superior improvements in spirometry findings, oxygenation, exercise tolerance, and possibly late survival; and (3) the superior improvements in function (and late survival) after bilateral lung transplantation may be attributed to the presence of more pulmonary reserve after the onset of obliterative bronchiolitis. (J THORACCARDIOVASCSURG1996;112:1485-95)

This article has been cited by other articles:

				N. Patel, M. DeCamp, and G. J. Criner Lung Transplantation and Lung Volume Reduction Surgery versus Transplantation in Chronic Obstructive Pulmonary Disease Proceedings of the ATS, May 1, 2008; 5(4): 447 - 453. [Abstract] [Full Text] [PDF]

				D. P. Mason, J. Rajeswaran, S. C. Murthy, A. M. McNeill, M. M. Budev, A. C. Mehta, G. B. Pettersson, and E. H. Blackstone Spirometry After Transplantation: How Much Better Are Two Lungs Than One? Ann. Thorac. Surg., April 1, 2008; 85(4): 1193 - 1201. [Abstract] [Full Text] [PDF]

				A. Y. Sheikh, M. P. Pelletier, and R. C. Robbins Heart-Lung and Lung Transplantation Card. Surg. Adult, January 1, 2008; 3(2008): 1579 - 1608. [Full Text]

				P. Botha, D. Trivedi, C. J. Weir, C. P. Searl, P. A. Corris, J. H. Dark, and S. V.B. Schueler Extended donor criteria in lung transplantation: Impact on organ allocation J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 1154 - 1160. [Abstract] [Full Text] [PDF]

				Pulmonary artery thrombosis caused by hyperinflation of the native lung six years after single lung transplantation for emphysema. J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 746 - 747.

				L. B. Balsam, D. D. Yuh, R. C. Robbins, and B. A. Reitz Heart-Lung and Lung Transplantation Card. Surg. Adult, January 1, 2003; 2(2003): 1461 - 1490. [Full Text]

				S. D. Cassivi, B. F. Meyers, R. J. Battafarano, T. J. Guthrie, E. P. Trulock, J. P. Lynch, J. D. Cooper, and G.A. Patterson Thirteen-year experience in lung transplantation for emphysema Ann. Thorac. Surg., November 1, 2002; 74(5): 1663 - 1670. [Abstract] [Full Text] [PDF]

				E. N. Mendeloff, B. F. Meyers, T. M. Sundt, T. J. Guthrie, S. C. Sweet, M. de la Morena, S. Shapiro, D. T. Balzer, E. P. Trulock, J. P. Lynch, et al. Lung transplantation for pulmonary vascular disease Ann. Thorac. Surg., January 1, 2002; 73(1): 209 - 219. [Abstract] [Full Text] [PDF]

				Managing stable chronic obstructive pulmonary disease DTB, November 1, 2001; 39(11): 81 - 85. [Abstract] [Full Text] [PDF]

				Y. Villaran, M. E. Sekela, and N. K. Burki Maximal Expiratory Flow Patterns After Single-Lung Transplantation in Patients With and Without Chronic Airways Obstruction Chest, January 1, 2001; 119(1): 163 - 168. [Abstract] [Full Text] [PDF]

				A. Pochettino, R. M. Kotloff, B. R. Rosengard, S. M. Arcasoy, N. P. Blumenthal, L. R. Kaiser, and J. E. Bavaria Bilateral versus single lung transplantation for chronic obstructive pulmonary disease: intermediate-term results Ann. Thorac. Surg., December 1, 2000; 70(6): 1813 - 1819. [Abstract] [Full Text] [PDF]

				B. F. Meyers, J. P. Lynch, E. P. Trulock, T. Guthrie, J. D. Cooper, and G. A. Patterson Single versus bilateral lung transplantation for idiopathic pulmonary fibrosisA ten-year institutional experience J. Thorac. Cardiovasc. Surg., July 1, 2000; 120(1): 99 - 107. [Abstract] [Full Text] [PDF]

				S. M. Arcasoy and R. M. Kotloff Lung Transplantation N. Engl. J. Med., April 8, 1999; 340(14): 1081 - 1091. [Full Text] [PDF]

				J. S. Gammie, R. J. Keenan, S. M. Pham, M. F. McGrath, B. G. Hattler, E. Khoshbin, and B. P. Griffith Single- Versus Double-Lung Transplantation For Pulmonary Hypertension J. Thorac. Cardiovasc. Surg., February 1, 1998; 115(2): 397 - 403. [Abstract] [Full Text]

				C. D. Sudarshan, S. C. Clark, and J. H. Dark Single or bilateral lung transplantation for chronic obstructive pulmonary disease J. Thorac. Cardiovasc. Surg., February 1, 1998; 115(2): 485 - 486. [Full Text]

				J. E. Bavaria, A. Pochettino, R. M. Kotloff, B. R. Rosengard, P. M. Wahl, Roberts, H. I. Palevsky, and L. R. Kaiser Effect of volume reduction on lung transplant timing and selection for chronic obstructive pulmonary disease J. Thorac. Cardiovasc. Surg., January 1, 1998; 115(1): 9 - 13. [Abstract] [Full Text] [PDF]