Langer Frank, Starniske Ina, Weingard Bettina, Aliyev Parviz, Mustafi Migdat, Bals Robert, Wilkens Heinrike
Department of Thoracic Surgery, Saarland University Medical Center, Homburg, Germany.
Department of Internal Medicine V, Pneumology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany.
JHLT Open. 2025 Feb 14;8:100229. doi: 10.1016/j.jhlto.2025.100229. eCollection 2025 May.
The implementation of the Lung Allocation Score in the Eurotransplant international collaborative framework decreased waiting list mortality, but organ shortage remains a significant problem. Single lung transplantation (sLTx)-whenever possible-may decrease waiting list mortality. We have consistently employed sLTx for recipients with pulmonary fibrosis. In the current investigation, we sought to analyze if this strategy can lead to an acceptable long-term outcome and if the side of sLTx has an impact on the outcome.
Between 1995 and 2024, we performed 138 sLTx for patients with pulmonary fibrosis (54 ± 9 years, 88 male). Data and outcomes were analyzed retrospectively comparing recipients receiving left sLTX ( = 98) and right sLTx ( = 40).
Survival was 83%, 59%, and 29% at 1, 5, and 10 years for the total patient cohort. Survival was similar for left and right sLTx (83 vs 81%, 58 vs 64%, and 29 vs 28% at 1, 5, and 10 years, = 0.54). Left and right transplantations lead to similar best post-transplant forced expiratory volume per second (74% ± 20% vs 74% ± 21%, = 0.86). While the total lung capacity (TLC) ratio TLC/predicted TLC was similar between groups (104% vs 100%), the ratio TLC/actual TLC was higher in left sLTx (185% vs 158%, = 0.04). On multivariate regression analysis, postoperative pneumonia ( = 0.003, hazard ratio 3.404) and sepsis ( = 0.002, hazard ratio 10.700) were identified as predictors for early mortality.
Performing sLTx for pulmonary fibrosis patients can be an effective strategy to optimize donor utilization and improve outcomes-irrespective of graft side.
在欧洲移植国际协作框架内实施肺分配评分降低了等待名单上的死亡率，但器官短缺仍然是一个重大问题。单肺移植（sLTx）——只要有可能——可能会降低等待名单上的死亡率。我们一直对肺纤维化患者采用sLTx。在当前的研究中，我们试图分析这种策略是否能带来可接受的长期结果，以及sLTx的植入侧是否会对结果产生影响。
1995年至2024年期间，我们对138例肺纤维化患者进行了sLTx（年龄54±9岁，男性88例）。对接受左肺sLTX（n = 98）和右肺sLTx（n = 40）的受者的数据和结果进行回顾性分析比较。
整个患者队列在1年、5年和10年时的生存率分别为83%、59%和29%。左肺和右肺sLTx的生存率相似（1年、5年和10年时分别为83%对81%、58%对64%和29%对28%，P = 0.54）。左肺和右肺移植术后的最佳一秒用力呼气量相似（74%±20%对74%±21%，P = 0.86）。虽然两组之间的肺总量（TLC）与预测TLC的比值相似（104%对100%），但左肺sLTx的TLC/实际TLC比值更高（185%对158%，P = 0.04）。多因素回归分析显示，术后肺炎（P = 0.003，风险比3.404）和败血症（P = 0.002，风险比10.700）是早期死亡的预测因素。
对肺纤维化患者进行sLTx可以是优化供体利用和改善结果的有效策略——无论移植侧如何。
