Staging of Bilateral Lung Transplantation for High‐Risk Patients With Interstitial Lung Disease: One Lung at a Time. Issue 11 (15th July 2016)

• Record Type: Journal Article
• Authors: Hartwig, M. G.; Ganapathi, A. M.; Osho, A. A.; Hirji, S. A.; Englum, B. R.; Speicher, P. J.; Palmer, S. M.; Davis, R. D.; Snyder, L. D.
• Is Part Of: American journal of transplantation. Volume 16:Issue 11(2016:Nov.)
• Page Start: 3270
• Page End: 3277
• Publication Date: 2016-07-15
• Subjects: clinical research/practice -- lung transplantation/pulmonology -- organ procurement and allocation -- organ allocation -- waitlist management; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.13892
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : The choice of a single or bilateral lung transplant for interstitial lung disease (ILD) is controversial, as surgical risk, long‐term survival and organ allocation are competing factors. In an effort to balance risk and benefit, our center adopted a staged bilateral lung transplant approach for higher surgical risk ILD patients where the patient has a single lung transplant followed by a second single transplant at a later date. We sought to understand the surgical risk, organ allocation and early outcomes of these staged bilateral recipients as a group and in comparison to matched single and bilateral recipients. Our analysis demonstrates that staged bilateral lung transplant recipients (n = 12) have a higher lung allocation score (LAS), lower pulmonary function tests and a lower glomerular filtration rate prior to the first transplant compared to the second (p < 0.01). There was a shorter length of hospital stay for the second transplant (p = 0.02). The staged bilateral compared to the single and bilateral case‐matched controls had comparable short‐term survival (p = 0.20) and pulmonary function tests at 1 year. There was a higher incidence of renal injury in the conventional bilateral group compared to the single and staged bilateral groups. The staged bilateral procedure is a viable option in select ILD patients. Abstract : Older recipients who undergo staged bilateral lung transplantation for interstitial lung disease have comparable survival and pulmonary function tests to single lung and bilateral lung transplant recipients with lower incidence of renal injury compared to conventional bilateral recipients.