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Clinical features and outcomes of unplanned single lung transplants

      Abstract

      Objective

      The decision to perform single lung transplants or double lung transplants is usually made before the operation. We have previously reported that a proportion of single lung transplants were unexpectedly performed in the setting of an aborted double lung transplant, and these patients may be at a higher risk of worse short-term outcomes. Long-term outcomes in unplanned single lung transplants remain unknown.

      Methods

      We analyzed a single-center database of lung transplants from 2000 to 2020. Single lung transplants were classified into planned and unplanned groups after reviewing operative notes. Root cause analysis was performed for unplanned single lung transplants.

      Results

      Of the 1326 lung transplants, 1265 (95%) were double lung transplants and 61 (5%) were single lung transplants (22 planned [36%], 39 unplanned [64%]). Underlying indications for transplant were significantly different; planned single lung transplant: chronic obstructive pulmonary disease (55%) and idiopathic pulmonary fibrosis (45%); unplanned single lung transplants: chronic obstructive pulmonary disease (23%), idiopathic pulmonary fibrosis (39%), and bronchiolitis obliterans syndrome (13%). The primary reasons for unplanned single lung transplant were donor-related (3, 7.7%), recipient-related (31, 80%), and donor and recipient-related factors (5, 13%). Unplanned single lung transplants were more likely to require cardiopulmonary bypass during the operation (planned: 4/22, 18% vs unplanned: 20/39, 51%) but had shorter ischemic times (planned: 251 ± 58 minutes vs unplanned: 221 ± 48 minutes). The 5-year overall survival was 53% in the planned and 58% in the unplanned groups, respectively (P = .323). No difference in chronic lung allograft dysfunction–free survival (P = .995) was observed.

      Conclusions

      Unplanned single lung transplants in the setting of aborted double lung transplant may be associated with acceptable long-term outcomes.

      Graphical abstract

      Key Words

      Abbreviations and Acronyms:

      ACR (acute cellular rejection), CLAD (chronic lung allograft dysfunction), COPD (chronic obstructive pulmonary disease), CPB (cardiopulmonary bypass), CT (computed tomography), DLT (double lung transplant), ECMO (extracorporeal membrane oxygenation), EVLP (ex vivo lung perfusion), IPF (idiopathic pulmonary fibrosis), ISHLT (International Society for Heart and Lung Transplantation), MCS (mechanical circulatory support), OPO (Organ Procurement Organization), OR (odds ratio), OS (overall survival), PGD (primary graft dysfunction), SLT (single lung transplant)
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