Transplanting both lungs in younger patients in the end stages of chronic obstructive pulmonary disease (COPD) gives longer survival than transplanting only one lung. This is the conclusion of authors of an Article in this week's edition of The Lancet.
Lung transplantation is the best treatment available for selected patients with end-stage lung diseases, including COPD. Reports* suggest that between 1995 and 2006, some 46% of lung transplants were done to teat COPD. Single and bilateral (both lung) transplantation are both recognised treatment options, but which procedure leads to longer survival is unclear.
Dr Gabriel Thabut, Service de Pneumologie B et transplantation pulmonaire, Hôpital Bichat, Paris, France, and colleagues, analysed data from 9883 COPD patients from the registry of the International Society for Heart and Lung Transplantation. Of these, 35.7% (3525) underwent bilateral lung transplantation (BLT) and 64.3% (6358) underwent single lung transplantation (SLT). All operations occurred between 1987 and 2006.
The researchers found that median survival time after BLT was longer than that for SLT -- 6.41 years versus 4.59 years. Pretransplant characteristics between SLT and BLT patients differed (eg, age, severity of disease), but whichever statistical method was used to adjust for baseline differences, BLT was still associated with longer survival than SLT. They also found this effect was much reduced in patients 60 years and older, with BLT showing only a small benefit in this patient group compared with SLT. Overall, all patients combined had better median survival in operations post-1998 (5.3 years) compared with those pre-1998 (4.5 years).
The authors conclude: "Bilateral lung transplantation leads to longer survival than single lung transplantation in patients with COPD, especially those who are younger than 60 years.....Any potential survival benefit of bilateral lung transplantation for individuals with COPD must be weighed against the potential societal benefits of allocation of organs to patients with advanced lung diseases."
In an accompanying Comment, Dr E Clinton Lawrence, McKelvey Center for Lung Transplantation and Pulmonary Vascular Diseases, Emory University School of Medicine, Atlanta, GA, USA discusses alternatives to lung transplantation such as surgical lung-volume reduction, use of endobronchial valves, pulmonary rehabilitation, and smoking cessation programmes.
He concludes: "Lung transplantation is an imperfect solution for COPD and other diseases, with a 5-year survival rate of about 50%. There is a limited supply of organs suitable for transplantation and patients, usually not those with COPD, die on waiting lists. Diminution of demand through smoking-prevention programmes is a far better alternative to lung transplantation."
Notes to editors: *2006 report of the International Registry of the International Society for Heart and Lung Transplantation.
Dr Gabriel Thabut, Service de Pneumologie B et transplantation pulmonaire, Hôpital Bichat, Paris, France, T) +33 140256912 / +33 611714190 E) Gabriel.thabut@bch.aphp.fr
Dr E Clinton Lawrence, McKelvey Center for Lung Transplantation and Pulmonary Vascular Diseases, Emory University School of Medicine, Atlanta, GA, USA T) +1 (404) 727-9651 E) clint.lawrence@emoryhealthcare.org
http://multimedia.thelancet.com/pdf/press/Lungtransplant.pdf
Journal
The Lancet