Single-lung transplantation for COPD improves access to transplantation without jeopardizing survival
Compared to single-lung transplantation (SLT), bilateral lung transplantation (BLT) improves survival in some patients with chronic obstructive pulmonary disease (COPD). However, a new study finds that adopting a strategy of SLT for patients with COPD could improve access to lung transplantation and reduce waitlist mortality, without jeopardizing overall post-transplant survival.
Researchers used a decision-analysis model to simulate the effect of SLT and BLT allocation strategies. They used data from patients listed for lung transplantation in the United Network for Organ Sharing Standard Transplant Analysis and Research file. When the model was used to simulate the waitlist experience of 1,000 patients, doing a SLT for patients with COPD resulted in 809 transplant recipients compared to 758 recipients under a BLT strategy. There were also fewer waitlist deaths with SLT (157) compared to BLT (199).
Post-transplant survival was similar for both approaches. In sensitivity analyses, SLT was always able to maximize the number of patients transplanted. Factors influencing the best strategy to maximize post-transplant survival included the relative survival benefit of BLT versus SLT, the donor interval, and the waitlist size. So while SLT always maximized access to transplantable lungs, BLT maximized the total number of life-years gained post-transplant when there were short waitlists or plentiful donors. Decisions about optimal allocation will therefore depend on whether society chooses to prioritize the number of patients transplanted or total post-transplant survival. Additionally, the best strategy may vary from region to region and even among different centers. The study was supported in part by the Agency for Healthcare Research and Quality (HS18406).
See "The societal impact of single versus bilateral lung transplantation for chronic obstructive pulmonary disease," by Jeffrey C. Munson, M.D., Jason D. Christie, M.D., and Scott D. Halpern, M.D., Ph.D., in the American Journal of Respiratory Critical Care Medicine 184, pp. 1282-1288, 2011.
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