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J Thorac Cardiovasc Surg 2007;133:532-540
© 2007 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Surgical patient outcomes after the increased use of bilateral lung transplantation

^a Section of Thoracic Surgery, University of Michigan Health System, Ann Arbor, Mich
^b Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Mich
^c Department of Biostatistics, University of Michigan Health System, Ann Arbor, Mich.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.

Received for publication April 28, 2006; revisions received September 3, 2006; accepted for publication September 26, 2006.

^_* Address for reprints: Andrew C. Chang, MD, Section of Thorracic Surgery, University of Michigan, TC2120G/0344, 1500 East Medical Center Dr, Ann Arbor, MI 48109. (Email: andrwchg{at}umich.edu).

OBJECTIVES: Despite the potential limitation of organ availability, several surgical groups have advocated preferential bilateral lung transplantation because of its demonstrated long-term survival advantage. Comparative results for single and sequential double lung transplantation performed at a single center are evaluated to determine whether such a policy improves patient outcome.

METHODS: A retrospective analysis of demographic and outcome data for patients undergoing lung transplantation was performed. Patients were grouped as single or double lung recipients and segregated into diagnostic categories according to the lung allocation scoring system. Era terciles were chosen on the basis of year of transplant, operating surgeon, and transplant volume.

RESULTS: Between November 1990 and September 2005, 344 lung transplant procedures were performed in 339 patients. Over three time periods evaluated, the proportion of patients undergoing double lung transplant procedures increased. Overall survivals at 3 months and 1, 3, and 5 years were 89%, 79%, 60%, and 52%, respectively. After adjusting for lung recipient characteristics, survival after double lung transplantation was improved when compared with single lung transplantation (P = .020). Overall patient survival among the three time periods was not significantly different at 30 days and 1 and 3 years despite increasing maximal donor organ ischemia times.

CONCLUSIONS: In this single-center study, despite longer median allograft ischemic times, as well as greater patient acuity as determined by listing diagnosis, overall early and midterm patient survival has remained higher than nationally reported figures. Bilateral lung transplantation in eligible patients is the procedure of choice.

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