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 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 TLC_donor/predicted TLC_recipient was similar between groups (104% vs 100%), the ratio TLC_donor/actual TLC_recipient 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.