Association of Graft Laterality With Outcomes After Single Lung Transplantation

To evaluate whether graft side (right versus left) is associated with outcomes after single lung transplantation (SLT) and to contextualize this association with lung function and perioperative complications.

Single-center retrospective cohort of adults transplanted from January 2018 to July 2025 with interstitial lung disease (ILD) or chronic obstructive pulmonary disease (COPD). Survival was evaluated with Kaplan-Meier and Cox models adjusted for clinical covariates. Postoperative respiratory infection was modeled with logistic regression. Longitudinal forced expiratory volume in 1 s was summarized.

Of 530 transplants, 319 met criteria (ILD n = 224; COPD n = 95). Survival differed by procedure (log-rank P = 0.0013). Compared with double lung transplantation, right SLT had higher mortality (hazard ratio [HR] 2.92, 95% CI 1.82-4.67, P < 0.0001), while left SLT did not (HR 1.07, 0.60-1.91, P = 0.82). The excess hazard with right SLT persisted within interstitial lung disease (HR 2.27, 1.28-4.05, P = 0.005) and COPD (HR 2.87, 1.33-6.19, P = 0.007). Primary graft dysfunction grade 3 (HR 2.39, 1.39-4.11, P = 0.002) and acute kidney injury (HR 2.12, 1.33-3.38, P = 0.002) were independently associated with mortality. Respiratory infections were frequent (∼40%-53%) without a clear difference by side; longer operative time correlated with infection (odds ratio 1.16 per h, 1.02-1.32, P = 0.02). Forced expiratory volume in 1 s peaked at 12-18 mo and declined thereafter, with no separation by side.

Right-but not left-SLT was associated with inferior long-term survival versus double lung transplantation. The lack of side-specific differences in spirometry and infection suggests that other factors may be relevant to the observed association between laterality and survival. Multicenter studies with time-varying covariates and physiologic imaging are warranted.