Outcomes of Single vs. Bilateral Lung Transplant in Patients with Chronic Obstructive Pulmonary Disease

Purpose There are contradictory reports on outcomes after bilateral lung transplant (BLT) vs. single lung transplant (SLT) in patients with COPD, which may be confounded by differences in allocation preferences and patient care between programs. We report outcomes of SLT vs. BLT for COPD at our center. Methods We retrospectively analyzed COPD patients who underwent SLT and BLT between Jan 2008 and Dec 2018. Pre- and post-transplant characteristics were compared between groups with chi‐square and t-tests. Unadjusted Kaplan‐Meier survival estimates were used to compare differences in freedom from CLAD (2019 ISHLT criteria) and allograft survival with log‐rank tests. Results 276 patients with COPD underwent LT (233 BLT and 43 SLT). SLTs were older than BLTs [median 63y (IQR 59-69) vs. 61y (IQR 57-67) p=0.04]. There were no other differences in baseline characteristics. SLTs had younger donors [median 27y (IQR 23-49) vs. 36y (IQR 22-53) p=0.01] and more often underwent EVLP [49% vs. 29% p=0.01]. BLTs required more intraoperative ECMO [14% vs. 2.3% p=0.03] and blood transfusion [40% vs. 19% p=0.02]. Mean post-transplant hospital and ICU length of stay was similar between groups [BLT 29.1d (95%CI 27.1-34.9) vs. SLT 23.5d (95% CI 19.6-27.5) p=0.11], and [BLT 6.8d (95%CI 5.3-8.1) vs. SLT 5.4d (95% CI 3.7-7.1) p=0.36]. Postoperative FEV1 and FVC were better in BLT [2.75L (95% CI 2.2-3.39) vs. 1.63L (95% CI 1.39-1.92) p Conclusion BLT for COPD resulted in better postoperative lung function and exercise capacity, but no significant differences in freedom from CLAD and allograft survival. There was a trend toward improved longer-term survival with BLT for COPD.