Does Side Matter? Effect of Single Lung Transplant Laterality on Outcomes

Abstract

Background: Previous works have suggested that recipients of left single lung transplant (SLT) have a worse outcome than those receiving right SLT. We evaluated the effect of SLT laterality on outcomes. Methods: We performed a retrospective study of SLT recipients followed up at our center. One hundred and nineteen patients were reviewed (53 left SLT, 66 right SLT). We extracted data on lung function, exercise capacity, relative graft perfusion, airway complications, acute rejection episodes, infections and mortality. Results: There was no significant difference between right and left lung recipients with regard to baseline demographic and physiological characteristics. Lung function, exercise capacity and relative graft perfusion improved in both groups following transplantation. We observed a higher graft perfusion in right-sided grafts compared to left (p = 0.048). There was no significant difference between the two groups in physiological outcomes, rejection or infection episodes, the presence of chronic rejection or mortality. We observed a statistically higher need for bronchial stent insertion during early follow-up amongst the left lung recipients (p = 0.022). Conclusions: Both right and left lungs are equally suitable for transplantation. The left-sided bronchial anastomosis may be more vulnerable to complications.

thoracic surgery - heart and lung transplantation - outcomes

References

• 1 Maurer J R, Frost A E, Estenne M, Higenbottam T, Glanville A R. International guidelines for the selection of lung transplant candidates. The International Society for Heart and Lung Transplantation, the American Thoracic Society, the American Society of Transplant Physicians, the European Respiratory Society.  J Heart Lung Transplant. 1998;  17 703-709
• 2 Orens J B, Estenne M, Arcasoy S et al. International guidelines for the selection of lung transplant candidates: 2006 update–a consensus report from the pulmonary scientific council of the International Society for Heart and Lung Transplantation.  J Heart Lung Transplant. 2006;  25 745-755
• 3 de Perrot M, Snell G I, Babcock W D et al. Strategies to optimize the use of currently available lung donors.  J Heart Lung Transplant. 2004;  23 1127-1134
• 4 Barr M L, Bourge R C, Orens J B et al. Thoracic organ transplantation in the United States, 1994–2003.  Am J Transplant. 2005;  5 934-949
• 5 Cai J. Thoracic transplantation in the United States: an analysis of UNOS registry data.  Clin Transpl. 2006;  41-56
• 6 Egan T M. Ethical issues in thoracic organ distribution for transplant.  Am J Transplant. 2003;  3 366-372
• 7 Snell G I, Shiraishi T, Griffiths A et al. Outcomes from paired single-lung transplants from the same donor.  J Heart Lung Transplant. 2000;  19 1056-1062
• 8 Smits J M A, Melman S, Mertens B J A, Laufer G, Persijn G G, van Raemdonck D. The Eurotransplant Study on Twin Lung Transplants (ESOTWIN): 90 paired single-lung transplants from the same donor.  Transplantation. 2003;  76 1604-1608
• 9 Estenne M, Maurer J R, Boehler A et al. Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria.  J Heart Lung Transplant. 2002;  21 297-310
• 10 Alvarez A, Algar J, Santos F et al. Airway complications after lung transplantation: a review of 151 anastomoses.  Eur J Cardiothorac Surg. 2001;  19 381-387
• 11 Samano M N, Minamoto H, Junqueira J J M et al. Bronchial complications following lung transplantation.  Transplant Proc. 2009;  41 921-926
• 12 Thistlethwaite P A, Yung G, Kemp A et al. Airway stenoses after lung transplantation: incidence, management, and outcome.  J Thorac Cardiovasc Surg. 2008;  136 1569-1575
• 13 Sommers K E, Griffith B P, Hardesty R L, Keenan R J. Early lung allograft function in twin recipients from the same donor: risk factor analysis.  Ann Thorac Surg. 1996;  62 784-790
• 14 Takao M, Namikawa S, Yuasa H et al. Airway complications after lung transplantation: is there a left-sided predilection?.  J Thorac Cardiovasc Surg. 1995;  109 815-817
• 15 Pinsker K L, Koerner S K, Kamholz S L, Hagstrom J W, Veith F J. Effect of donor bronchial length on healing: a canine model to evaluate bronchial anastomotic problems in lung transplantation.  J Thorac Cardiovasc Surg. 1979;  77 669-673
• 16 Van De Wauwera C, Van Raemdoncka D, Verledenb G M et al. Risk factors for airway complications within the first year after lung transplantation.  Eur J Cardiothorac Surg. 2007;  31 703-710
• 17 Garfein E S, Ginsberg M E, Gorenstein L, McGregor C C, Schulman L L. Superiority of end-to-end versus telescoped bronchial anastomosis in single lung transplantation for pulmonary emphysema.  J Thorac Cardiovasc Surg. 2001;  121 149-154
• 18 Burns K E A, Orons P D, Dauber J H et al. Endobronchial metallic stent placement for airway complications after lung transplantation: longitudinal results.  Ann Thorac Surg. 2002;  74 1934-1941
• 19 Kapoor B S, May B, Panu N, Kowalik K, Hunter D W. Endobronchial stent placement for the management of airway complications after lung transplantation.  J Vasc Interv Radiol. 2007;  18 629-632
• 20 Hardoff R, Steinmetz A P, Krausz Y, Bar-Sever Z, Liani M, Kramer M R. The prognostic value of perfusion lung scintigraphy in patients who underwent single-lung transplantation for emphysema and pulmonary fibrosis.  J Nucl Med. 2000;  41 1771-1776