Department of Respiratory and Critical Care Medicine, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China.
Department of Thoracic Surgery, The second affiliated hospital of Nanchang University, Nanchang, China.
Transplantation. 2019 Dec;103(12):2634-2644. doi: 10.1097/TP.0000000000002841.
Both bilateral lung transplantation (BLT) and single lung transplantation (SLT) are commonly used, but which method is better remains controversial. This meta-analysis was conducted to compare the 2 surgical procedures to identify a better clinical choice.
Cohort studies comparing SLT and BLT were identified by conducting searches of databases and screening references of retrieved articles. Survival, pulmonary function, surgical indicators, and complications were compared between the 2 groups.
Thirty studies (1980 recipients in the SLT group and 2112 recipients in the BLT group) were pooled in the meta-analysis. The long-term overall survival rate (OSR) (OSR-4y and OSR-5y), bronchiolitis obliterans syndrome (BOS)-free survival, BOS-free survival rate (BFSR) (2-5 y), 6-minute walking distance, forced expiratory volume in 1 second (%), forced vital capacity (%), oxygenation index, pulmonary arterial pressure, Arterial partial pressure of oxygen (Pao2), diffusing capacity of the lung for carbon monoxide (Dlco), and BOS were better in the BLT group than in the SLT group. The advantages shown in the BLT group compared with the SLT group in regard to these variables increased with the prolongation of survival time. However, surgical time, ischemic time, postoperative intensive care unit days, and postoperative hospital days were shorter in the SLT group than in the BLT group. Overall survival, short-term OSR (1-3 y), BSFR-1y, in-hospital mortality, postoperative ventilator days, and postoperative complications (except BOS) were similar between the 2 groups. Bacterial pneumonia, graft failure, fungal infection, cardiac arrhythmia, and hemorrhage were the top 5 causes of in-hospital mortality.
BLT appears to be associated with better long-term survival, better postoperative lung function, and less BOS compared with SLT. In-hospital mortality and postoperative complications (except BOS) were similar between the 2 groups.
双侧肺移植（BLT）和单侧肺移植（SLT）均为常用术式，但哪种术式更优仍存在争议。本研究旨在通过荟萃分析比较这两种术式，为临床选择提供参考。
通过检索数据库和筛选检索文献的参考文献，确定比较 SLT 和 BLT 的队列研究。比较两组间的生存率、肺功能、手术指标和并发症。
共纳入 30 项研究（SLT 组 1980 例，BLT 组 2112 例）。BLT 组的长期总体生存率（OSR）（OSR-4y 和 OSR-5y）、闭塞性细支气管炎综合征（BOS）无失败生存率、BOS 无失败生存率（2-5 年）、6 分钟步行距离、1 秒用力呼气容积（%）、用力肺活量（%）、氧合指数、肺动脉压、动脉血氧分压（Pao2）、一氧化碳弥散量（Dlco）和 BOS 优于 SLT 组。BLT 组在这些变量方面优于 SLT 组的优势随着生存时间的延长而增加。然而，SLT 组的手术时间、缺血时间、术后重症监护病房天数和术后住院天数均短于 BLT 组。两组间总体生存率、短期 OSR（1-3 年）、BSFR-1y、住院死亡率、术后呼吸机使用天数和术后并发症（除外 BOS）相似。细菌性肺炎、移植物失功、真菌感染、心律失常和出血是导致住院死亡的前 5 大原因。
与 SLT 相比，BLT 似乎与长期生存率提高、术后肺功能改善和 BOS 发生率降低相关。两组间的住院死亡率和术后并发症（除外 BOS）相似。
