FOR older adults undergoing lung transplantation, the decision between single lung transplantation (SLT) and bilateral lung transplantation (BLT) presents a trade-off between short-term recovery and long-term survival. A new analysis of nearly 10,000 patients aged 65 and older reveals that while SLT results in lower morbidity and shorter hospital stays, BLT offers a significant long-term survival advantage.
The study, utilizing data from the Scientific Registry of Transplant Recipients (2005–2022), compared outcomes for 4,829 patients who underwent SLT and 5,075 who received BLT. Propensity-matched analysis of 2,539 patients in each group found that SLT recipients had shorter hospital stays (14 vs. 18 days), lower reintubation rates (14.7% vs. 19.8%), and reduced need for post-transplant dialysis (4.2% vs. 6.4%). Early survival was comparable, with a 30-day survival rate of 97.6% for SLT vs. 97.3% for BLT, and a one-year survival rate of 85.5% vs. 86.3%.
However, long-term outcomes favored BLT. At 5 years post-transplant, survival rates declined to 45.4% for SLT recipients compared to 53.4% for BLT. SLT was identified as a risk factor for 5-year mortality (adjusted hazard ratio, 1.19; P < .001), suggesting that while SLT may be an appropriate choice for older adults at high risk of not tolerating BLT, it comes with a notable reduction in long-term survival. These findings highlight the need for individualized decision-making in older lung transplant candidates, balancing the benefits of lower perioperative risk against the potential for improved longevity with BLT. Reference: Anaya Malik | AMJ
