Neel K Ranganath1, Jad Malas2, Katherine G Phillips2, Melissa B Lesko3, Deane E Smith2, Luis F Angel3, Bonnie E Lonze4, Zachary N Kon2. 1. Division of Cardiac Surgery, Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York. Electronic address: neel.ranganath@nyulangone.org. 2. Division of Cardiac Surgery, Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York. 3. Department of Medicine, NYU Langone Health, New York, New York. 4. Department of Surgery, Transplant Institute, NYU Langone Health, New York, New York.
Abstract
BACKGROUND: Several studies have described improved survival with double lung transplant (DLT) compared with single lung transplant (SLT) in pulmonary fibrosis. To avoid the innate selection bias of including patients exclusively listed for SLT or DLT, this study analyzed those deemed appropriate for either procedure at time of listing. METHODS: All consecutive adult lung transplants for idiopathic pulmonary fibrosis provided by the Scientific Registry of Transplant Recipients were retrospectively reviewed (2007-2017). Isolated lobar transplants (n = 11) or patients listed only for SLT (n = 1834) or DLT (n = 2372) were excluded. Group stratification was based on the ultimate procedure (SLT vs DLT). Group propensity matching was performed based on 24 recipient and donor characteristics. Recipient demographics, donor demographics, and outcomes were compared between groups. RESULTS: During the study period 45% (974/2179) and 55% (1205/2179) of patients ultimately received SLT and DLT, respectively. After propensity matching 466 matched patients remained in each group. SLT patients were less likely to require prolonged (>48 hours) ventilator support than DLT patients. There was also a trend toward reduced rates of posttransplant renal failure and hospital length of stay in SLT recipients. Whether analyzed by time of listing or time of transplant, survival was similar between groups. CONCLUSIONS: In recipients concurrently listed for SLT and DLT overall survival was similar regardless of the eventual procedure. These data suggest that the previously purported survival advantage for DLT may purely represent selection bias and should not preclude the use of SLT in appropriately selected idiopathic pulmonary fibrosis patients.
BACKGROUND: Several studies have described improved survival with double lung transplant (DLT) compared with single lung transplant (SLT) in pulmonary fibrosis. To avoid the innate selection bias of including patients exclusively listed for SLT or DLT, this study analyzed those deemed appropriate for either procedure at time of listing. METHODS: All consecutive adult lung transplants for idiopathic pulmonary fibrosis provided by the Scientific Registry of Transplant Recipients were retrospectively reviewed (2007-2017). Isolated lobar transplants (n = 11) or patients listed only for SLT (n = 1834) or DLT (n = 2372) were excluded. Group stratification was based on the ultimate procedure (SLT vs DLT). Group propensity matching was performed based on 24 recipient and donor characteristics. Recipient demographics, donor demographics, and outcomes were compared between groups. RESULTS: During the study period 45% (974/2179) and 55% (1205/2179) of patients ultimately received SLT and DLT, respectively. After propensity matching 466 matched patients remained in each group. SLT patients were less likely to require prolonged (>48 hours) ventilator support than DLT patients. There was also a trend toward reduced rates of posttransplant renal failure and hospital length of stay in SLT recipients. Whether analyzed by time of listing or time of transplant, survival was similar between groups. CONCLUSIONS: In recipients concurrently listed for SLT and DLT overall survival was similar regardless of the eventual procedure. These data suggest that the previously purported survival advantage for DLT may purely represent selection bias and should not preclude the use of SLT in appropriately selected idiopathic pulmonary fibrosispatients.
Authors: Francis T Delaney; John G Murray; Barry D Hutchinson; Jim J Egan; Michelle Murray; Sara Winward; Nicola Ronan; Carmel G Cronin Journal: Eur Radiol Date: 2022-06-16 Impact factor: 5.315
Authors: Danial Ahmad; Thomas J O'Malley; Andrew M Jordan; Elizabeth J Maynes; Abhiraj Saxena; Kyle W Prochno; Taufiek K Rajab; Howard T Massey; Richard C Daly; Vakhtang Tchantchaleishvili Journal: J Thorac Dis Date: 2022-09 Impact factor: 3.005