Assessing the benefit of accepting a single lung offer now compared with waiting for a subsequent double lung offer

Comparisons of survival after single lung transplant (SLT) and bilateral lung transplant (BLT) are useful in making policy decisions, but a more relevant comparison for an individual patient is between accepting a single lung when offered and remaining on the waiting list with the potential to subsequently receive a suitable pair of lungs.

U.K. data from a cohort of 1211 adult, first lung transplant candidates diagnosed with pulmonary fibrosis (PF) or chronic obstructive pulmonary disease (COPD), listed July 1995 to July 2006 and followed up till December 2007, were analyzed. A sequentially stratified proportional hazards model was used to assess mortality after SLT relative to continued waiting for BLT.

For patients with PF, SLT was associated with a significant reduction in hazard relative to waiting for BLT (hazard ratio 0.81, 95% confidence interval 0.68-0.97, P=0.021), particularly for older patients with body mass index less than 20 and forced expired volume in 1 sec is less than 1 L. In contrast, our results gave no support for accepting SLT rather than waiting for BLT for patients with COPD (hazard ratio 1.08, 95% confidence interval 0.92-1.29, P=0.35).

The high pretransplant risk of death for patients with PF, particularly older patients with low body mass index and poor lung function, suggests that they would benefit from taking an SLT if offered. However, there is no benefit of accepting SLT rather than waiting for BLT for patients with COPD; this reflects the low relative hazard in the absence of transplant for these patients.