Weingarten Noah, Mehta Atul C, Budev Marie, Ahmad Usman, Yun James, McCurry Kenneth, Elgharably Haytham
Department of Surgery, University of Pennsylvania, Philadelphia, PA.
Respiratory Institute, Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH.
Chest. 2025 Feb;167(2):518-528. doi: 10.1016/j.chest.2024.08.044. Epub 2024 Sep 5.
Single lung transplantation (SLT) has been shown to be associated with worse long-term outcomes than bilateral lung transplantation (BLT), but often is performed in older adults at risk of not tolerating BLT.
How do the outcomes of SLT and BLT compare among older adult recipients?
The Scientific Registry of Transplant Recipients database (2005-2022) was queried for lung transplant recipients aged 65 years older. Patients were stratified by whether they underwent BLT or SLT and were propensity matched. Baseline characteristics and morbidity were compared with frequentist statistics. Survival was analyzed via Kaplan-Meier estimation. Risk factors for mortality were identified with Cox regression.
Of 9,904 included patients, 4,829 patients (48.8%) underwent SLT. Patients who underwent SLT had lower lung allocation scores (39.6 vs 40.6; P < .001), more interstitial lung disease (74.4% vs 64.6%; P < .001), and lower rates of bridging (0.7% vs 2.4%; P < .001). Groups did not differ significantly by sex, BMI, or donor characteristics. Propensity matching resulted in 2,539 patients in each group. On matched analysis, patients undergoing SLT had shorter lengths of stay (14 days vs 18 day), lower reintubation rates (14.7% vs 19.8%), and less postoperative dialysis use (4.2% vs 6.4%; P < .001 for all). Patients who underwent SLT had comparable survival at 30 days (97.6% vs 97.3%; P = .414) and 1 year (85.5% vs 86.3%; P = .496), but lower survival at 5 years (45.4% vs 53.4%; P < .001) on matched analysis. SLT was a risk factor for 5-year mortality (adjusted hazard ratio, 1.19; P < .001).
Our findings show that in older adults, SLT is associated with less morbidity and comparable early survival relative to BLT, but lower 5-year survival. This suggests that SLT is reasonable to perform in older adults at high risk of not tolerating BLT.
单肺移植（SLT）已被证明与比双肺移植（BLT）更差的长期预后相关，但通常在无法耐受BLT的老年患者中进行。
老年受者中SLT和BLT的预后如何比较？
查询移植受者科学登记数据库（2005 - 2022年）中年龄在65岁及以上的肺移植受者。患者按是否接受BLT或SLT分层，并进行倾向匹配。使用频率统计比较基线特征和发病率。通过Kaplan-Meier估计分析生存率。用Cox回归确定死亡风险因素。
在纳入的9904例患者中，4829例患者（48.8%）接受了SLT。接受SLT的患者肺分配评分较低（39.6对40.6；P <.001），间质性肺疾病更多（74.4%对64.6%；P <.001），桥接率较低（0.7%对2.4%；P <.001）。两组在性别、体重指数或供体特征方面无显著差异。倾向匹配后每组有2539例患者。在匹配分析中，接受SLT的患者住院时间较短（14天对18天），再插管率较低（14.7%对19.8%），术后透析使用率较低（4.2%对6.4%；所有P <.001）。接受SLT的患者在30天（97.6%对97.3%；P =.414）和1年（85.5%对86.3%；P =.496）时的生存率相当，但在匹配分析中5年生存率较低（45.4%对53.4%；P <.001）。SLT是5年死亡的风险因素（调整后的风险比，1.19；P <.001）。
我们的研究结果表明，在老年人中，与BLT相比，SLT的发病率较低且早期生存率相当，但5年生存率较低。这表明在无法耐受BLT的高风险老年患者中进行SLT是合理的。
