Researchers in France and the US have concluded that for younger patients in the final stages of chronic obstructive pulmonary disease (COPD), survival is lengthened by transplanting both lungs compared to only one lung. The study, performed by Dr Gabriel Thabut, Service de Pneumologie B et transplantation pulmonaire, Hôpital Bichat, Paris, France, and colleagues, is published in the journal The Lancet.
COPD includes several diseases that limit airflow to the lungs, such as chronic bronchitis and emphysema, for example. Often, patients with end-stage lung diseases such as COPD can benefit most from lung transplantation. About 46% of lung transplants were performed in order to treat COPD from 1995 to 2006. This statistic includes both single and bilateral (both lung) transplantation, and the focus of this current research is to see which procedure leads to longer survival.
The researchers used data from the registry of the International Society for Heart and Lung Transplantation. Of 9,883 COPD patients between 1987 and 2006, 3,525 (35.7%) had bilateral lung transplantation (BLT) and 6,358 (64.3%) received single lung transplantation (SLT).
The median survival time after BLT was 6.41 years compared to 4.59 years for SLT patients. Thabut and colleagues used various statistical methods to control for pre-transplant characteristics, and with each method BLT continued to be associated with longer survival times than SLT.
“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,” note Thabut and colleagues.
For patients 60 years and older, the researchers found that BLT only had a small benefit in survival time compared to SLT. In addition, the researchers analyzed results with respect to time period. Patients who had an operation before 1998 had shorter survival times than those who had one after 1998 – median time of 4.5 years (pre-1998) compared to 5.3 years (post-1998).
An accompanying Comment by Dr E Clinton Lawrence, McKelvey Center for Lung Transplantation and Pulmonary Vascular Diseases, Emory University School of Medicine, Atlanta, GA, USA suggests that rather than lung transplantation, doctors and patients should consider options such as: surgical lung-volume reduction, use of endobronchial valves, lung rehabilitation, and programs to quit smoking.
He writes: “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.”
Survival after bilateral versus single lung transplantation for patients with chronic obstructive pulmonary disease: a retrospective analysis of registry data
Dr Gabriel Thabut MD, Jason D Christie MD, Prof Philippe Ravaud MD, Yves Castier MD, Olivier Brugière MD, Prof Michel Fournier MD, Prof Hervé Mal MD, Prof Guy Lesèche MD, and Raphaël Porcher PhD
The Lancet (2008). 371:744-751
doi:10.1016/S0140-6736(08)60344-X
Written by: Peter M Crosta