Background: The decision to perform single-lung (SLT) or bilateral sequential lung (BSLT) transplantation in patients with pulmonary fibrosis is controversial. Some centers use recipient age (<50 years) as a criterion to select BSLT over SLT, but the rationale for this approach is not well established.
Methods: Eight hundred twenty-one patients (636 SLT, 185 BSLT), aged 30 to 69 years, who were recipients of transplants for pulmonary fibrosis in the United States between 1994 and 2000 were reported to the United Network for Organ Sharing. Survival was compared by procedure type within three age groups (30 to 49 years, 50 to 59 years, and 60 to 69 years) using the Kaplan-Meier method. Multivariate logistic regression analysis was used to calculate risk-adjusted mortality within 1-month after transplantation, and proportional hazards regression was used to calculate risk-adjusted mortality after 1 month.
Results: Early (1-month) and late (3-year) survival in recipients aged 30 to 49 years was significantly better with SLT than BSLT (early, 90.9% versus 77.1%; late, 63.8% versus 46.2%, respectively; p = 0.02). Survival was also significantly better with SLT than BSLT at these time points in those patients aged 50 to 59 years (early, 89.5% versus 81.7%; late, 53.6% versus 46.7%, respectively; p = 0.03). When posttransplant survival was reanalyzed contingent on survival to 1 month, no significant difference in survival by procedure type (SLT versus BSLT) was detected for any age group. Multivariate analysis of survival, adjusted for other known risk factors, as well as propensity analysis, yielded similar results.
Conclusions: Patients younger than 60 years of age who were recipients of transplants for pulmonary fibrosis appear to have better survival with SLT than with BSLT. Although the basis for this observation is unclear, events occurring in the early period (first month) after transplantation may play a role. Further studies will be needed, but these data do not appear to support the preferential use of BSLT for younger patients with pulmonary fibrosis.