Lung transplant outcomes in recipients waitlisted for both single and double lung transplantation

Double lung transplantation (DLTx) generally provides better survival than single lung transplantation (SLTx). However, SLTx recipients may often be more deconditioned, making direct comparisons challenging. The objective of this study is to investigate the transplant outcomes in patients waitlisted for both SLTx and DLTx to minimize differences in recipient background.

The United Network for Organ Sharing Database was retrospectively analyzed. The patients who were waitlisted from December 2017 to February 2023, then removed from the waiting list in the same time periods, were included in the analysis. Pediatric lung transplantation, multiorgan transplantation, and lung retransplantation were excluded.

Of 4056 patients who were waitlisted for both SLTx and DLTx, 2127 patients (52.4%) received DLTx, 1351 patients (33.3%) received SLTx, and 578 patients (14.3%) were removed from waiting list without receiving lung transplantation. Median days on the waitlist were 36 days (IQR 12-93) for DLTx and 43 days (IQR 15-120) for SLTx. The lung allocation score at the time of transplantation was higher in DLTx group (50.58 ± 19.02 vs 44.67 ± 14.80, p < 0.001). DLTx recipients had significantly higher rates of prolonged intubation at 72 hours after transplantation (33.9% vs 19.9%, p < 0.001) and reintubation (19.3% vs 13.0%, p < 0.001). Median post-transplant length of hospital stay was longer in DLTx group (19 [IQR 14-33] vs 15 days [IQR 11-24], p < 0.001). However, DLTx group had significantly lower mortality than SLTx group (n = 3478, log-rank test p < 0.001).

Among patients waitlisted for both DLTx and SLTx, DLTx recipients had lower post-transplant mortality, despite a more complicated immediate postoperative course compared to SLTx.