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Lung transplantation: Disease-based choice of procedure

Author
Ramsey R Hachem, MD
Section Editor
Elbert P Trulock, MD
Deputy Editor
Helen Hollingsworth, MD

INTRODUCTION

Lung and heart-lung transplantation have been performed for most end-stage lung diseases. The different lung transplant procedures, the most common diseases that require lung transplant, and how the underlying lung disease affects the choice of procedure will be reviewed here.

An overview of lung transplantation, indications and organizational process, outcomes, international guidelines for recipient selection, and indications for lung transplantation are presented separately. (See "Lung transplantation: An overview" and "Lung transplantation: General guidelines for recipient selection".)

OVERVIEW OF TYPES OF LUNG TRANSPLANT

Until 1989, combined heart-lung transplant (HLT) was the most common form of lung transplantation in the United States. Subsequently, single lung transplantation (SLT) became the most common procedure; however, the proportion of bilateral lung transplants (BLT) has now surpassed SLT (figure 1) [1,2]. In addition to these procedures, split lung bilateral lobar transplants and living donor lobar lung transplants were once occasionally performed but have largely fallen out of favor in recent years [3]. The reasons for choosing one procedure over another are reviewed here. An overview of the operative techniques is provided separately. (See "Lung transplantation: Procedure and postoperative management".)

According to the 2015 Registry report, the median survival for all adult recipients is 5.7 years, but bilateral lung recipients appear to have a better median survival than single lung recipients (7 versus 4.5 years, respectively) (For a figure showing updated information, please see the International Society for Heart and Lung Transplantation slide set "Overall Lung and Adult Lung Transplantation Statistics," slide titled Number of Lung Transplants Performed by Year and Procedure Type at: ISHLT Registry) [2]. However, it is unclear if this survival advantage is directly related to the type of operation or to the underlying recipient characteristics.

The general characteristics and advantages/disadvantages of the different types of lung transplantation are discussed in the following sections.

              

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Literature review current through: Nov 2016. | This topic last updated: Tue Mar 29 00:00:00 GMT+00:00 2016.
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References
Top
  1. Whelan TP, Dunitz JM, Kelly RF, et al. Effect of preoperative pulmonary artery pressure on early survival after lung transplantation for idiopathic pulmonary fibrosis. J Heart Lung Transplant 2005; 24:1269.
  2. Yusen RD, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-second Official Adult Lung and Heart-Lung Transplantation Report--2015; Focus Theme: Early Graft Failure. J Heart Lung Transplant 2015; 34:1264.
  3. http://optn.transplant.hrsa.gov/latestData/rptData.asp (Accessed on February 27, 2014).
  4. Sundaresan S, Semenkovich J, Ochoa L, et al. Successful outcome of lung transplantation is not compromised by the use of marginal donor lungs. J Thorac Cardiovasc Surg 1995; 109:1075.
  5. Low DE, Trulock EP, Kaiser LR, et al. Morbidity, mortality, and early results of single versus bilateral lung transplantation for emphysema. J Thorac Cardiovasc Surg 1992; 103:1119.
  6. Couetil JP, Tolan MJ, Loulmet DF, et al. Pulmonary bipartitioning and lobar transplantation: a new approach to donor organ shortage. J Thorac Cardiovasc Surg 1997; 113:529.
  7. Artemiou O, Birsan T, Taghavi S, et al. Bilateral lobar transplantation with the split lung technique. J Thorac Cardiovasc Surg 1999; 118:369.
  8. Mitilian D, Sage E, Puyo P, et al. Techniques and results of lobar lung transplantations. Eur J Cardiothorac Surg 2014; 45:365.
  9. Starnes VA, Barr ML, Cohen RG. Lobar transplantation. Indications, technique, and outcome. J Thorac Cardiovasc Surg 1994; 108:403.
  10. Starnes VA, Barr ML, Cohen RG, et al. Living-donor lobar lung transplantation experience: intermediate results. J Thorac Cardiovasc Surg 1996; 112:1284.
  11. Organ Procurement and Transplantation Network. National data on transplants by donor type. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/ (Accessed on March 18, 2016).
  12. Pasque MK, Trulock EP, Kaiser LR, Cooper JD. Single-lung transplantation for pulmonary hypertension. Three-month hemodynamic follow-up. Circulation 1991; 84:2275.
  13. Ritchie M, Waggoner AD, Dávila-Román VG, et al. Echocardiographic characterization of the improvement in right ventricular function in patients with severe pulmonary hypertension after single-lung transplantation. J Am Coll Cardiol 1993; 22:1170.
  14. Kramer MR, Valantine HA, Marshall SE, et al. Recovery of the right ventricle after single-lung transplantation in pulmonary hypertension. Am J Cardiol 1994; 73:494.
  15. Bando K, Armitage JM, Paradis IL, et al. Indications for and results of single, bilateral, and heart-lung transplantation for pulmonary hypertension. J Thorac Cardiovasc Surg 1994; 108:1056.
  16. Pasque MK, Trulock EP, Cooper JD, et al. Single lung transplantation for pulmonary hypertension. Single institution experience in 34 patients. Circulation 1995; 92:2252.
  17. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/# (Accessed on March 07, 2016).
  18. Valapour M, Skeans MA, Smith JM, et al. Lung. Am J Transplant 2016; 16 Suppl 2:141.
  19. Nathan SD. Lung transplantation: disease-specific considerations for referral. Chest 2005; 127:1006.
  20. American Thoracic Society, European Respiratory Society. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001. Am J Respir Crit Care Med 2002; 165:277.
  21. Kim DS, Collard HR, King TE Jr. Classification and natural history of the idiopathic interstitial pneumonias. Proc Am Thorac Soc 2006; 3:285.
  22. Martinez FJ, Safrin S, Weycker D, et al. The clinical course of patients with idiopathic pulmonary fibrosis. Ann Intern Med 2005; 142:963.
  23. Walter N, Collard HR, King TE Jr. Current perspectives on the treatment of idiopathic pulmonary fibrosis. Proc Am Thorac Soc 2006; 3:330.
  24. Thabut G, Mal H, Castier Y, et al. Survival benefit of lung transplantation for patients with idiopathic pulmonary fibrosis. J Thorac Cardiovasc Surg 2003; 126:469.
  25. Unilateral lung transplantation for pulmonary fibrosis. Toronto Lung Transplant Group. N Engl J Med 1986; 314:1140.
  26. Meyers BF, Lynch JP, Trulock EP, et al. Single versus bilateral lung transplantation for idiopathic pulmonary fibrosis: a ten-year institutional experience. J Thorac Cardiovasc Surg 2000; 120:99.
  27. Meyer DM, Edwards LB, Torres F, et al. Impact of recipient age and procedure type on survival after lung transplantation for pulmonary fibrosis. Ann Thorac Surg 2005; 79:950.
  28. Christie JD, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: Twenty-eighth Adult Lung and Heart-Lung Transplant Report--2011. J Heart Lung Transplant 2011; 30:1104.
  29. Weiss ES, Allen JG, Merlo CA, et al. Survival after single versus bilateral lung transplantation for high-risk patients with pulmonary fibrosis. Ann Thorac Surg 2009; 88:1616.
  30. International Registry for Heart and Lung Transplantation: Adult lung transplantation statistics. http://www.ishlt.org/registries/slides.asp?slides=heartLungRegistry (Accessed on March 12, 2015).
  31. Schaffer JM, Singh SK, Reitz BA, et al. Single- vs double-lung transplantation in patients with chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis since the implementation of lung allocation based on medical need. JAMA 2015; 313:936.
  32. Gulack BC, Ganapathi AM, Speicher PJ, et al. What Is the Optimal Transplant for Older Patients With Idiopathic Pulmonary Fibrosis? Ann Thorac Surg 2015; 100:1826.
  33. Nathan SD, Shlobin OA, Ahmad S, et al. Comparison of wait times and mortality for idiopathic pulmonary fibrosis patients listed for single or bilateral lung transplantation. J Heart Lung Transplant 2010; 29:1165.
  34. Date H, Tanimoto Y, Goto K, et al. A new treatment strategy for advanced idiopathic interstitial pneumonia: living-donor lobar lung transplantation. Chest 2005; 128:1364.
  35. Patterson GA, Maurer JR, Williams TJ, et al. Comparison of outcomes of double and single lung transplantation for obstructive lung disease. The Toronto Lung Transplant Group. J Thorac Cardiovasc Surg 1991; 101:623.
  36. Mal H, Sleiman C, Jebrak G, et al. Functional results of single-lung transplantation for chronic obstructive lung disease. Am J Respir Crit Care Med 1994; 149:1476.
  37. Levine SM, Anzueto A, Peters JI, et al. Medium term functional results of single-lung transplantation for endstage obstructive lung disease. Am J Respir Crit Care Med 1994; 150:398.
  38. Brunsting LA, Lupinetti FM, Cascade PN, et al. Pulmonary function in single lung transplantation for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg 1994; 107:1337.
  39. Fishman A, Martinez F, Naunheim K, et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med 2003; 348:2059.
  40. Sundaresan RS, Shiraishi Y, Trulock EP, et al. Single or bilateral lung transplantation for emphysema? J Thorac Cardiovasc Surg 1996; 112:1485.
  41. Trulock EP, Edwards LB, Taylor DO, et al. Registry of the International Society for Heart and Lung Transplantation: twenty-second official adult lung and heart-lung transplant report--2005. J Heart Lung Transplant 2005; 24:956.
  42. Meyer DM, Bennett LE, Novick RJ, Hosenpud JD. Single vs bilateral, sequential lung transplantation for end-stage emphysema: influence of recipient age on survival and secondary end-points. J Heart Lung Transplant 2001; 20:935.
  43. Thabut G, Christie JD, Ravaud P, et al. Survival after bilateral versus single lung transplantation for patients with chronic obstructive pulmonary disease: a retrospective analysis of registry data. Lancet 2008; 371:744.
  44. Thabut G, Ravaud P, Christie JD, et al. Determinants of the survival benefit of lung transplantation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008; 177:1156.
  45. Schulman LL, O'Hair DP, Cantu E, et al. Salvage by volume reduction of chronic allograft rejection in emphysema. J Heart Lung Transplant 1999; 18:107.
  46. Hadjiliadis D, Chaparro C, Gutierrez C, et al. Impact of lung transplant operation on bronchiolitis obliterans syndrome in patients with chronic obstructive pulmonary disease. Am J Transplant 2006; 6:183.
  47. Mason DP, Rajeswaran J, Murthy SC, et al. Spirometry after transplantation: how much better are two lungs than one? Ann Thorac Surg 2008; 85:1193.
  48. Levy RD, Ernst P, Levine SM, et al. Exercise performance after lung transplantation. J Heart Lung Transplant 1993; 12:27.
  49. Pochettino A, Kotloff RM, Rosengard BR, et al. Bilateral versus single lung transplantation for chronic obstructive pulmonary disease: intermediate-term results. Ann Thorac Surg 2000; 70:1813.
  50. Weill D, Benden C, Corris PA, et al. A consensus document for the selection of lung transplant candidates: 2014--an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2015; 34:1.
  51. Cystic Fibrosis Foundation. Lung transplantation. http://www.cff.org/treatments/LungTransplantation/.
  52. de Leval MR, Smyth R, Whitehead B, et al. Heart and lung transplantation for terminal cystic fibrosis. A 4 1/2-year experience. J Thorac Cardiovasc Surg 1991; 101:633.
  53. Ganesh JS, Rogers CA, Bonser RS, et al. Outcome of heart-lung and bilateral sequential lung transplantation for cystic fibrosis: a UK national study. Eur Respir J 2005; 25:964.
  54. Vricella LA, Karamichalis JM, Ahmad S, et al. Lung and heart-lung transplantation in patients with end-stage cystic fibrosis: the Stanford experience. Ann Thorac Surg 2002; 74:13.
  55. Egan TM, Detterbeck FC, Mill MR, et al. Improved results of lung transplantation for patients with cystic fibrosis. J Thorac Cardiovasc Surg 1995; 109:224.
  56. Yankaskas JR, Mallory GB Jr. Lung transplantation in cystic fibrosis: consensus conference statement. Chest 1998; 113:217.
  57. Bowdish ME, Pessotto R, Barbers RG, et al. Long-term pulmonary function after living-donor lobar lung transplantation in adults. Ann Thorac Surg 2005; 79:418.
  58. Barr ML, Schenkel FA, Bowdish ME, Starnes VA. Living donor lobar lung transplantation: current status and future directions. Transplant Proc 2005; 37:3983.
  59. Bowdish ME, Barr ML, Schenkel FA, et al. A decade of living lobar lung transplantation: perioperative complications after 253 donor lobectomies. Am J Transplant 2004; 4:1283.
  60. Piotrowski JA, Splittgerber FH, Donovan TJ, et al. Single-lung transplantation in a patient with cystic fibrosis and an asymmetric thorax. Ann Thorac Surg 1997; 64:1456.
  61. Forty J, Hasan A, Gould FK, et al. Single lung transplantation with simultaneous contralateral pneumonectomy for cystic fibrosis. J Heart Lung Transplant 1994; 13:727.
  62. Couetil JP, Houssin DP, Soubrane O, et al. Combined lung and liver transplantation in patients with cystic fibrosis. A 4 1/2-year experience. J Thorac Cardiovasc Surg 1995; 110:1415.
  63. Doyle RL, McCrory D, Channick RN, et al. Surgical treatments/interventions for pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest 2004; 126:63S.
  64. Goldstein BS, Sweet SC, Mao J, et al. Lung transplantation in children with idiopathic pulmonary arterial hypertension: an 18-year experience. J Heart Lung Transplant 2011; 30:1148.
  65. Levine SM, Gibbons WJ, Bryan CL, et al. Single lung transplantation for primary pulmonary hypertension. Chest 1990; 98:1107.
  66. Gammie JS, Keenan RJ, Pham SM, et al. Single- versus double-lung transplantation for pulmonary hypertension. J Thorac Cardiovasc Surg 1998; 115:397.
  67. Mendeloff EN, Meyers BF, Sundt TM, et al. Lung transplantation for pulmonary vascular disease. Ann Thorac Surg 2002; 73:209.
  68. Levine SM, Jenkinson SG, Bryan CL, et al. Ventilation-perfusion inequalities during graft rejection in patients undergoing single lung transplantation for primary pulmonary hypertension. Chest 1992; 101:401.
  69. Reitz BA, Wallwork JL, Hunt SA, et al. Heart-lung transplantation: successful therapy for patients with pulmonary vascular disease. N Engl J Med 1982; 306:557.
  70. Chapelier A, Vouhé P, Macchiarini P, et al. Comparative outcome of heart-lung and lung transplantation for pulmonary hypertension. J Thorac Cardiovasc Surg 1993; 106:299.
  71. Waddell TK, Bennett L, Kennedy R, et al. Heart-lung or lung transplantation for Eisenmenger syndrome. J Heart Lung Transplant 2002; 21:731.
  72. Hopkins WE, Ochoa LL, Richardson GW, Trulock EP. Comparison of the hemodynamics and survival of adults with severe primary pulmonary hypertension or Eisenmenger syndrome. J Heart Lung Transplant 1996; 15:100.
  73. Charman SC, Sharples LD, McNeil KD, Wallwork J. Assessment of survival benefit after lung transplantation by patient diagnosis. J Heart Lung Transplant 2002; 21:226.
  74. Fitton TP, Kosowski TR, Barreiro CJ, et al. Impact of secondary pulmonary hypertension on lung transplant outcome. J Heart Lung Transplant 2005; 24:1254.
  75. Aokage K, Date H, Okazaki M, et al. Living-donor lobar lung transplantation and closure of atrial septal defect for adult Eisenmenger's syndrome. J Heart Lung Transplant 2009; 28:1107.
  76. Thomas M, Belli EV, Rawal B, et al. Survival After Lung Retransplantation in the United States in the Current Era (2004 to 2013): Better or Worse? Ann Thorac Surg 2015; 100:452.