CHEST Guidelines-Make-Mine-a-Double

Make-Mine-a-Double_chest

Pdf Summary

The debate over the optimal type of lung transplantation—single (SLT) versus bilateral (BLT)—continues to be a significant topic in the treatment of terminal lung disease. Both approaches have their respective advocates. Generally, BLT is associated with better long-term survival and pulmonary function than SLT, although it poses greater short-term risks. Conversely, SLT is linked to less short-term morbidity, making it a preferred choice for older patients with lower functional status or higher risk for postoperative complications. The absence of high-quality prospective data means decisions often rely on smaller series, registry-based studies, or institutional preferences.<br /><br />Recent analysis by Weingarten et al. has reinforced these findings, showing improved long-term outcomes with BLT for the general recipient population. However, selection bias is a concern in many studies, as patients are often preselected for either SLT or BLT, which can affect perceived survival advantages. There are also scenarios, such as certain cases of secondary pulmonary hypertension, where BLT is evidently superior to SLT.<br /><br />An often-discussed societal advantage of SLT is that it theoretically allows for two transplant recipients from one donor. However, logistical and medical issues mean this potential isn't always realized. Furthermore, right SLTs generally result in better long-term outcomes compared to left SLTs, raising questions about the justice and utility of lung allocation.<br /><br />Ultimately, the choice between SLT and BLT must take into account individual patient factors and broader ethical considerations. While BLT may provide greater individual benefits, SLT has certain utilitarian advantages that can't be overlooked. The ongoing debate underscores the complex dynamics in optimizing lung transplantation strategies.

Keywords

lung transplantation

single lung transplant

bilateral lung transplant

terminal lung disease

long-term survival

short-term morbidity

selection bias

pulmonary hypertension

lung allocation

ethical considerations