Single lung transplantation for pulmonary fibrosis: Does side matter?
Background: The implementation of the Lung Allocation Score in the Eurotransplant international collaborative framework decreased waiting list mortality, but organ shortage remains a significant problem. Single lung transplantation (sLTx)—whenever possible—may decrease waiting list mortality. We hav...
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Elsevier
2025-05-01
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| author | Frank Langer Ina Starniske Bettina Weingard Parviz Aliyev Migdat Mustafi Robert Bals Heinrike Wilkens |
| author_facet | Frank Langer Ina Starniske Bettina Weingard Parviz Aliyev Migdat Mustafi Robert Bals Heinrike Wilkens |
| author_sort | Frank Langer |
| collection | DOAJ |
| description | Background: The implementation of the Lung Allocation Score in the Eurotransplant international collaborative framework decreased waiting list mortality, but organ shortage remains a significant problem. Single lung transplantation (sLTx)—whenever possible—may decrease waiting list mortality. We have consistently employed sLTx for recipients with pulmonary fibrosis. In the current investigation, we sought to analyze if this strategy can lead to an acceptable long-term outcome and if the side of sLTx has an impact on the outcome. Methods: Between 1995 and 2024, we performed 138 sLTx for patients with pulmonary fibrosis (54 ± 9 years, 88 male). Data and outcomes were analyzed retrospectively comparing recipients receiving left sLTX (n = 98) and right sLTx (n = 40). Results: Survival was 83%, 59%, and 29% at 1, 5, and 10 years for the total patient cohort. Survival was similar for left and right sLTx (83 vs 81%, 58 vs 64%, and 29 vs 28% at 1, 5, and 10 years, p = 0.54). Left and right transplantations lead to similar best post-transplant forced expiratory volume per second (74% ± 20% vs 74% ± 21%, p = 0.86). While the total lung capacity (TLC) ratio TLCdonor/predicted TLCrecipient was similar between groups (104% vs 100%), the ratio TLCdonor/actual TLCrecipient was higher in left sLTx (185% vs 158%, p = 0.04). On multivariate regression analysis, postoperative pneumonia (p = 0.003, hazard ratio 3.404) and sepsis (p = 0.002, hazard ratio 10.700) were identified as predictors for early mortality. Conclusions: Performing sLTx for pulmonary fibrosis patients can be an effective strategy to optimize donor utilization and improve outcomes—irrespective of graft side. |
| format | Article |
| id | doaj-art-aac9460283af408e9c1bd6c44b76739a |
| institution | DOAJ |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-aac9460283af408e9c1bd6c44b76739a2025-08-20T02:56:06ZengElsevierJHLT Open2950-13342025-05-01810022910.1016/j.jhlto.2025.100229Single lung transplantation for pulmonary fibrosis: Does side matter?Frank Langer0Ina Starniske1Bettina Weingard2Parviz Aliyev3Migdat Mustafi4Robert Bals5Heinrike Wilkens6Department of Thoracic Surgery, Saarland University Medical Center, Homburg, Germany; Corresponding author: Frank Langer, Department of Thoracic Surgery, Saarland University Medical Center, 66424 Homburg, Germany.Department of Thoracic Surgery, Saarland University Medical Center, Homburg, GermanyDepartment of Internal Medicine V, Pneumology and Intensive Care Medicine, Saarland University Medical Center, Homburg, GermanyDepartment of Thoracic Surgery, Saarland University Medical Center, Homburg, GermanyDepartment of Thoracic Surgery, Saarland University Medical Center, Homburg, GermanyDepartment of Internal Medicine V, Pneumology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany; Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Center for Infection Research (HZI), Saarland University Campus, Saarbrücken, GermanyDepartment of Internal Medicine V, Pneumology and Intensive Care Medicine, Saarland University Medical Center, Homburg, GermanyBackground: The implementation of the Lung Allocation Score in the Eurotransplant international collaborative framework decreased waiting list mortality, but organ shortage remains a significant problem. Single lung transplantation (sLTx)—whenever possible—may decrease waiting list mortality. We have consistently employed sLTx for recipients with pulmonary fibrosis. In the current investigation, we sought to analyze if this strategy can lead to an acceptable long-term outcome and if the side of sLTx has an impact on the outcome. Methods: Between 1995 and 2024, we performed 138 sLTx for patients with pulmonary fibrosis (54 ± 9 years, 88 male). Data and outcomes were analyzed retrospectively comparing recipients receiving left sLTX (n = 98) and right sLTx (n = 40). Results: Survival was 83%, 59%, and 29% at 1, 5, and 10 years for the total patient cohort. Survival was similar for left and right sLTx (83 vs 81%, 58 vs 64%, and 29 vs 28% at 1, 5, and 10 years, p = 0.54). Left and right transplantations lead to similar best post-transplant forced expiratory volume per second (74% ± 20% vs 74% ± 21%, p = 0.86). While the total lung capacity (TLC) ratio TLCdonor/predicted TLCrecipient was similar between groups (104% vs 100%), the ratio TLCdonor/actual TLCrecipient was higher in left sLTx (185% vs 158%, p = 0.04). On multivariate regression analysis, postoperative pneumonia (p = 0.003, hazard ratio 3.404) and sepsis (p = 0.002, hazard ratio 10.700) were identified as predictors for early mortality. Conclusions: Performing sLTx for pulmonary fibrosis patients can be an effective strategy to optimize donor utilization and improve outcomes—irrespective of graft side.http://www.sciencedirect.com/science/article/pii/S2950133425000242lung transplantationsingle lung transplantationinterstitial lung diseasepulmonary fibrosisdonor lung sizing |
| spellingShingle | Frank Langer Ina Starniske Bettina Weingard Parviz Aliyev Migdat Mustafi Robert Bals Heinrike Wilkens Single lung transplantation for pulmonary fibrosis: Does side matter? JHLT Open lung transplantation single lung transplantation interstitial lung disease pulmonary fibrosis donor lung sizing |
| title | Single lung transplantation for pulmonary fibrosis: Does side matter? |
| title_full | Single lung transplantation for pulmonary fibrosis: Does side matter? |
| title_fullStr | Single lung transplantation for pulmonary fibrosis: Does side matter? |
| title_full_unstemmed | Single lung transplantation for pulmonary fibrosis: Does side matter? |
| title_short | Single lung transplantation for pulmonary fibrosis: Does side matter? |
| title_sort | single lung transplantation for pulmonary fibrosis does side matter |
| topic | lung transplantation single lung transplantation interstitial lung disease pulmonary fibrosis donor lung sizing |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425000242 |
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