[Lung transplantation at the Papworth Hospital: 9-year experience]

To review and compare our results for single lung transplantation (SLT) and double lung transplantation (DLT).

One hundred twenty-three patients transplanted between September 1988 and July 1997 (99 SLT and 24 DLT) were reviewed. Mean follow-up was 749 days.

The following variables were significantly different for the two recipient populations: the most common indication was restriction for SLT and sepsis for DLT; mean ages were 50.3 +/- 9.2 and 40.6 +/- 14.3 for SLT and DLT, respectively; and nutritional status measured as body mass index was 21.5 +/- 4 for SLT and 18.6 +/- 2.7 for DLT. DLT patients experienced longer periods of ischemia during surgery (287 +/- 75 min versus 242 +/- 65 min for SLT, p = 0.01) and more of them required extracorporeal circulation (67% versus 37%, p = 0.005). Early postoperative morbidity after DLT was greater because of bleeding (1,046 +/- 848 ml versus 690 +/- 503 ml; p = 0.01) and time of intubation (9 hours, interquartile range 7 to 13 for DLT patients versus 5 hours, interquartile range 1 to 10 for SLT; p = 0.001). DLT recipients also suffered more respiratory infections during the first 3 months after surgery. Long term, DLT patients had greater pulmonary function capacity than did SLT patients, a difference that was maintained over the three years of follow-up. Readmission was more frequent among DLT patients because of infection (0.40 versus 0.26 readmissions per patient per 100 days; p < 0.02).

Both unilateral and bilateral lung transplants are valid therapeutic options for patients with terminal phase lung disease. DLT offers more hope of long term functional recovery without negatively affecting survival.