CHEST Guidelines-Single-vs Double-Lung-Transplantation-in-Olde

Single-vs Double-Lung-Transplantation-in-Olde

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A study by Noah Weingarten, MD, et al. analyzed the outcomes of single lung transplantation (SLT) versus bilateral lung transplantation (BLT) in older adults, specifically those aged 65 and over, using data from the Scientific Registry of Transplant Recipients between 2005 and 2022. The analysis included 9,904 transplant recipients, with 4,829 undergoing SLT and 5,075 undergoing BLT. The study employed propensity matching methods to ensure groups were comparable.<br /><br />The results indicated that SLT recipients experienced less morbidity, with shorter hospital stays, lower reintubation rates, and less postoperative dialysis compared to BLT recipients. At short-term intervals, survival rates between SLT and BLT were similar at 30 days (97.6% vs 97.3%) and at 1 year (85.5% vs 86.3%). However, at 5 years, SLT recipients showed significantly lower survival rates (45.4% vs 53.4%), making SLT a risk factor for 5-year mortality.<br /><br />Despite this, due to lesser early postoperative complications and the comparable short-term mortality data, SLT remains a viable option for older adults who may not withstand the complexity and higher physiological demands of BLT. The authors noted that although SLT is linked to higher acute rejection rates, it still serves as a reasonable surgical option for older adults, especially those unable to tolerate BLT.<br /><br />This study highlights considerations for transplant decisions in older adults, balancing short-term postoperative benefits against slightly poorer long-term survival, emphasizing the need for personalized, case-by-case evaluations by transplant teams. Implications include that SLT could allow more patients to receive transplants, thus reducing waitlist times and potentially lowering waitlist-associated mortality. However, decisions must consider individual patient profiles and potential postoperative outcomes.

Keywords

lung transplantation

older adults

single lung transplant

bilateral lung transplant

postoperative outcomes

survival rates

propensity matching

acute rejection

waitlist mortality

personalized evaluation