Evaluation of the long-term results of single lung versus heart-lung transplantation for emphysema.

BACKGROUND

Heart and lung transplantation used to be the standard operation for patients with emphysema. Because of the shortage of donors, more patients are having single lung transplantation with satisfactory short-term results.

METHODS

This study was performed to evaluate the long-term results of both groups. During the period between December 1985 and December 1993, 89 patients underwent lung transplantation, and 68 patients (43 male and 25 female) underwent single lung transplantation. There were 31 right and 37 left single lung transplantations with 24 bronchial revascularization procedures.

RESULTS

The actuarial 5-year survival was 67% +/- 0.3% in single lung and 60% +/- 0.2% in heart-lung groups (p = 0.947). In the single lung group, two patients required a second single lung for air trapping and 11 patients (16%) had obliterative bronchiolitis, two of whom required retransplantation. In the heart-lung group, four patients (19%) had obliterative bronchiolitis, two of whom required retransplantation. The cumulative probability of developing obliterative brochiolitis at 3 and 5 years was 17% and 38% in the heart-lung transplantation group and 23% and 48% in the single lung transplantation group, respectively. The average forced expiratory volumes in 1 second at 3 and 5 years were 1.6 and 1.4 (L/min) (standard error +/- L/min) for single lung and 3 and 2.9 (L/min) standard error +/- 0.25) for heart-lung transplant recipients, respectively. The percentage of the predicted maximum oxygen consumption was 42% and 58% in single lung and heart lung groups, respectively.

CONCLUSIONS

The long-term results in respiratory function, exercise capacity, and the quality of life of heart-lung transplant recipients are significantly better with survival compared with single lung transplant recipients. Although single lung transplantation for patients with emphysema makes better use of organs, the long-term results when compared with those of the heart-lung group needs to be evaluated further.