Single versus bilateral lung transplantation in end-stage chronic obstructive pulmonary disease: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GENG Yuhan ¹ , MA Long ² , MA Yongming ² , SUN Jingyang ² , LIU Bin ¹ , YANG Yi ³ , JIN Gang ³ ,  ZHU Zijiang ⁴

1. Ningxia Medical University, Yinchuan, 750000, P. R. China;
2. The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
3. The Second Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;
4. Department of Thoracic Surgery, Gansu Provincial Central Hospital, Lanzhou, 730000, P. R. China;

Corresponding author：

ZHU Zijiang, Email: zhuzijiang2008@163.com

Keywords：

Single lung transplantation; bilateral lung transplantation; chronic obstructive pulmonary disease; overall survival; complication

DOI：

10.7507/1007-4848.202305017

Video：

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Objective To systematically evaluate the efficacy and safety of single lung transplantation (SLT) and bilateral lung transplantation (BLT) in the treatment of end-stage chronic obstructive pulmonary disease (COPD). Methods Chinese and English databases were searched by computer, including PubMed, Web of Science, The Cochrane Library, EMbase, CNKI, Wanfang database, VIP database and CBM. Case-control studies on single lung transplantation or bilateral lung transplantation for COPD were collected from the inception to July 31, 2022. We evaluated the quality of the literature via Newcastle-Ottawa Scale. All results were analyzed using Review Manager V5.3 and STATA 17. Results A total of 14076 patients were included in 8 literatures, including 8326 patients in the single lung transplantation group and 5750 patients in the bilateral lung transplantation group. The results of meta-analysis showed that there was no significant difference in the 1-year postoperative survival between the two groups (P=0.070). The 2-year survival rate (P=0.002), 3-year survival rate (P<0.001), 5-year survival rate (P<0.001), overall survival rate (P＜0.001), postoperative forced expiratory volume in one second/predicted value (P<0.001), postoperative forced vital capacity (P<0.001), postoperative 6-minute walking distance (P=0.002) were lower or shorter than those in the bilateral lung transplantation group, the postoperative intubation time (P=0.030) was longer than that in the bilateral lung transplantation group. Bilateral lung transplantation group showed better surgical results. There were no statistical differences in the mortality, obliterative bronchiolitis, length of hospitalization, primary graft dysfunction, or postoperative adverse events (P>0.05). Conclusion Bilateral lung transplantation is associated with better long-term survival and postoperative lung function compared with single lung transplantation. In-hospital mortality and postoperative complications were similar between them.

1.	Christenson SA, Smith BM, Bafadhel M, et al. Chronic obstructive pulmonary disease. Lancet, 2022, 399(10342): 2227-2242.
2.	Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2095-2128.
3.	Zhou Y, Zhong NS, Li X, et al. Tiotropium in early-stage chronic obstructive pulmonary disease. N Engl J Med, 2017, 377(10): 923-935.
4.	Vega-Sánchez ÁE, Téllez-Navarrete NA, Pérez-Padilla R. Chronic obstructive pulmonary disease: Perspectives for primary health care. Rev Invest Clin, 2019, 71(1): 55-63.
5.	Chambers DC, Perch M, Zuckermann A, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-eighth adult lung transplantation report-2021; Focus on recipient characteristics. J Heart Lung Transplant, 2021, 40(10): 1060-1072.
6.	Mutyala S, Kashem MA, Kanaparthi J, et al. Comparing outcomes in patients with end-stage chronic obstructive pulmonary disease: Single versus bilateral lung transplants. Interact Cardiovasc Thorac Surg, 2021, 33(5): 807-813.
7.	Yusen RD, Edwards LB, Dipchand AI, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-third adult lung and heart-lung transplant report-2016; Focus theme: Primary diagnostic indications for transplant. J Heart Lung Transplant, 2016, 35(10): 1170-1184.
8.	Calhoon JH, Grover FL, Gibbons WJ, et al. Single lung transplantation. Alternative indications and technique. J Thorac Cardiovasc Surg, 1991, 101(5): 816-825.
9.	Kaiser LR, Cooper JD, Trulock EP, et al. The evolution of single lung transplantation for emphysema. The Washington University Lung Transplant Group. J Thorac Cardiovasc Surg, 1991, 102(3): 333-341.
10.	Bavaria JE, Kotloff R, Palevsky H, et al. Bilateral versus single lung transplantation for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg, 1997, 113(3): 520-527.
11.	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(6): 1813-1818.
12.	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(9614): 744-751.
13.	Bando K, Paradis IL, Keenan RJ, et al. Comparison of outcomes after single and bilateral lung transplantation for obstructive lung disease. J Heart Lung Transplant, 1995, 14(4): 692-698.
14.	Yu H, Bian T, Yu Z, et al. Bilateral lung transplantation provides better long-term survival and pulmonary function than single lung transplantation: A systematic review and meta-analysis. Transplantation, 2019, 103(12): 2634-2644.
15.	Li D, Liu Y, Wang B. Single versus bilateral lung transplantation in idiopathic pulmonary fibrosis: A systematic review and meta-analysis. PLoS One, 2020, 15(5): e0233732.
16.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
17.	Bartram U, Demertzis S, Heilmann M, et al. Unilateral vs. bilateral lung transplantation in obstructive pulmonary disease. Med Klin (Munich), 1997, 92 Suppl 5: 8-14.
18.	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(9): 936-948.
19.	Bennett DT, Zamora M, Reece TB, et al. Continued utility of single-lung transplantation in select populations: Chronic obstructive pulmonary disease. Ann Thorac Surg, 2015, 100(2): 437-442.
20.	Schneeberger T, Gloeckl R, Welte T, et al. Pulmonary rehabilitation outcomes after single or double lung transplantation in patients with chronic obstructive pulmonary disease or interstitial lung disease. Respiration, 2017, 94(2): 178-185.
21.	Latos M, Nęcki M, Pawlak D, et al. Outcome of lung transplantation as a treatment of patients with chronic obstructive pulmonary disease: A single-center study. Transplant Proc, 2020, 52(7): 2118-2122.
22.	Yeung JC, Keshavjee S. Overview of clinical lung transplantation. Cold Spring Harb Perspect Med, 2014, 4(1): a015628.
23.	Hartwig MG, Ganapathi AM, Osho AA, et al. Staging of bilateral lung transplantation for high-risk patients with interstitial lung disease: One lung at a time. Am J Transplant, 2016, 16(11): 3270-3277.
24.	Leard LE, Holm AM, Valapour M, et al. Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. J Heart Lung Transplant, 2021, 40(11): 1349-1379.
25.	Toronto Lung Transplant Group. Unilateral lung transplantation for pulmonary fibrosis. N Engl J Med, 1986, 314(18): 1140-1145.
26.	Puri V, Patterson GA, Meyers BF. Single versus bilateral lung transplantation: Do guidelines exist?. Thorac Surg Clin, 2015, 25(1): 47-54.
27.	Chambers DC, Cherikh WS, Goldfarb SB, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-fifth adult lung and heart-lung transplant report-2018; Focus theme: Multiorgan transplantation. J Heart Lung Transplant, 2018, 37(10): 1169-1183.
28.	Valapour M, Paulson K, Smith JM, et al. OPTN/SRTR 2011 Annual Data Report: Lung. Am J Transplant, 2013, 13 Suppl 1: 149-177.
29.	Subramanian MP, Meyers BF. Bilateral versus single lung transplantation: Are two lungs better than one?. J Thorac Dis, 2018, 10(7): 4588-4601.
30.	Fakhro M, Broberg E, Algotsson L, et al. Double lung, unlike single lung transplantation might provide a protective effect on mortality and bronchiolitis obliterans syndrome. J Cardiothorac Surg, 2017, 12(1): 100.
31.	Gerbase MW, Spiliopoulos A, Rochat T, et al. Health-related quality of life following single or bilateral lung transplantation: A 7-year comparison to functional outcome. Chest, 2005, 128(3): 1371-1378.
32.	Sekulovski M, Simonska B, Peruhova M, et al. Factors affecting complications development and mortality after single lung transplant. World J Transplant, 2021, 11(8): 320-334.
33.	Mineura K, Chen-Yoshikawa TF, Tanaka S, et al. Native lung complications after living-donor lobar lung transplantation. J Heart Lung Transplant, 2021, 40(5): 343-350.
34.	Mohanka MR, Kanade R, Garcia H, et al. Significance of best spirometry in the first year after bilateral lung transplantation: Association with 3-year outcomes. Transplantation, 2020, 104(8): 1712-1719.
35.	De Groote A, Van Muylem A, Scillia P, et al. Ventilation asymmetry after transplantation for emphysema: Role of chest wall and mediastinum. Am J Respir Crit Care Med, 2004, 170(11): 1233-1238.
36.	Porteous MK, Lee JC. Primary graft dysfunction after lung transplantation. Clin Chest Med, 2017, 38(4): 641-654.
37.	Liu Y, Liu Y, Su L, et al. Recipient-related clinical risk factors for primary graft dysfunction after lung transplantation: A systematic review and meta-analysis. PLoS One, 2014, 9(3): e92773.
38.	Fernandez R, Chiu S, Raparia K, et al. Humoral human lung allograft rejection by tissue-restricted non-HLA antibodies. Ann Thorac Surg, 2016, 102(4): e339-e341.
39.	Whited WM, Henley P, Schumer EM, et al. Does donor age and double versus single lung transplant affect survival of young recipients?. Ann Thorac Surg, 2018, 105(1): 235-241.
40.	Salamo O, Roghaee S, Schweitzer MD, et al. White donor, younger donor and double lung transplant are associated with better survival in sarcoidosis patients. Sci Rep, 2018, 8(1): 6968.

1. Christenson SA, Smith BM, Bafadhel M, et al. Chronic obstructive pulmonary disease. Lancet, 2022, 399(10342): 2227-2242.
2. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2095-2128.
3. Zhou Y, Zhong NS, Li X, et al. Tiotropium in early-stage chronic obstructive pulmonary disease. N Engl J Med, 2017, 377(10): 923-935.
4. Vega-Sánchez ÁE, Téllez-Navarrete NA, Pérez-Padilla R. Chronic obstructive pulmonary disease: Perspectives for primary health care. Rev Invest Clin, 2019, 71(1): 55-63.
5. Chambers DC, Perch M, Zuckermann A, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-eighth adult lung transplantation report-2021; Focus on recipient characteristics. J Heart Lung Transplant, 2021, 40(10): 1060-1072.
6. Mutyala S, Kashem MA, Kanaparthi J, et al. Comparing outcomes in patients with end-stage chronic obstructive pulmonary disease: Single versus bilateral lung transplants. Interact Cardiovasc Thorac Surg, 2021, 33(5): 807-813.
7. Yusen RD, Edwards LB, Dipchand AI, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-third adult lung and heart-lung transplant report-2016; Focus theme: Primary diagnostic indications for transplant. J Heart Lung Transplant, 2016, 35(10): 1170-1184.
8. Calhoon JH, Grover FL, Gibbons WJ, et al. Single lung transplantation. Alternative indications and technique. J Thorac Cardiovasc Surg, 1991, 101(5): 816-825.
9. Kaiser LR, Cooper JD, Trulock EP, et al. The evolution of single lung transplantation for emphysema. The Washington University Lung Transplant Group. J Thorac Cardiovasc Surg, 1991, 102(3): 333-341.
10. Bavaria JE, Kotloff R, Palevsky H, et al. Bilateral versus single lung transplantation for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg, 1997, 113(3): 520-527.
11. 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(6): 1813-1818.
12. 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(9614): 744-751.
13. Bando K, Paradis IL, Keenan RJ, et al. Comparison of outcomes after single and bilateral lung transplantation for obstructive lung disease. J Heart Lung Transplant, 1995, 14(4): 692-698.
14. Yu H, Bian T, Yu Z, et al. Bilateral lung transplantation provides better long-term survival and pulmonary function than single lung transplantation: A systematic review and meta-analysis. Transplantation, 2019, 103(12): 2634-2644.
15. Li D, Liu Y, Wang B. Single versus bilateral lung transplantation in idiopathic pulmonary fibrosis: A systematic review and meta-analysis. PLoS One, 2020, 15(5): e0233732.
16. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
17. Bartram U, Demertzis S, Heilmann M, et al. Unilateral vs. bilateral lung transplantation in obstructive pulmonary disease. Med Klin (Munich), 1997, 92 Suppl 5: 8-14.
18. 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(9): 936-948.
19. Bennett DT, Zamora M, Reece TB, et al. Continued utility of single-lung transplantation in select populations: Chronic obstructive pulmonary disease. Ann Thorac Surg, 2015, 100(2): 437-442.
20. Schneeberger T, Gloeckl R, Welte T, et al. Pulmonary rehabilitation outcomes after single or double lung transplantation in patients with chronic obstructive pulmonary disease or interstitial lung disease. Respiration, 2017, 94(2): 178-185.
21. Latos M, Nęcki M, Pawlak D, et al. Outcome of lung transplantation as a treatment of patients with chronic obstructive pulmonary disease: A single-center study. Transplant Proc, 2020, 52(7): 2118-2122.
22. Yeung JC, Keshavjee S. Overview of clinical lung transplantation. Cold Spring Harb Perspect Med, 2014, 4(1): a015628.
23. Hartwig MG, Ganapathi AM, Osho AA, et al. Staging of bilateral lung transplantation for high-risk patients with interstitial lung disease: One lung at a time. Am J Transplant, 2016, 16(11): 3270-3277.
24. Leard LE, Holm AM, Valapour M, et al. Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. J Heart Lung Transplant, 2021, 40(11): 1349-1379.
25. Toronto Lung Transplant Group. Unilateral lung transplantation for pulmonary fibrosis. N Engl J Med, 1986, 314(18): 1140-1145.
26. Puri V, Patterson GA, Meyers BF. Single versus bilateral lung transplantation: Do guidelines exist?. Thorac Surg Clin, 2015, 25(1): 47-54.
27. Chambers DC, Cherikh WS, Goldfarb SB, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-fifth adult lung and heart-lung transplant report-2018; Focus theme: Multiorgan transplantation. J Heart Lung Transplant, 2018, 37(10): 1169-1183.
28. Valapour M, Paulson K, Smith JM, et al. OPTN/SRTR 2011 Annual Data Report: Lung. Am J Transplant, 2013, 13 Suppl 1: 149-177.
29. Subramanian MP, Meyers BF. Bilateral versus single lung transplantation: Are two lungs better than one?. J Thorac Dis, 2018, 10(7): 4588-4601.
30. Fakhro M, Broberg E, Algotsson L, et al. Double lung, unlike single lung transplantation might provide a protective effect on mortality and bronchiolitis obliterans syndrome. J Cardiothorac Surg, 2017, 12(1): 100.
31. Gerbase MW, Spiliopoulos A, Rochat T, et al. Health-related quality of life following single or bilateral lung transplantation: A 7-year comparison to functional outcome. Chest, 2005, 128(3): 1371-1378.
32. Sekulovski M, Simonska B, Peruhova M, et al. Factors affecting complications development and mortality after single lung transplant. World J Transplant, 2021, 11(8): 320-334.
33. Mineura K, Chen-Yoshikawa TF, Tanaka S, et al. Native lung complications after living-donor lobar lung transplantation. J Heart Lung Transplant, 2021, 40(5): 343-350.
34. Mohanka MR, Kanade R, Garcia H, et al. Significance of best spirometry in the first year after bilateral lung transplantation: Association with 3-year outcomes. Transplantation, 2020, 104(8): 1712-1719.
35. De Groote A, Van Muylem A, Scillia P, et al. Ventilation asymmetry after transplantation for emphysema: Role of chest wall and mediastinum. Am J Respir Crit Care Med, 2004, 170(11): 1233-1238.
36. Porteous MK, Lee JC. Primary graft dysfunction after lung transplantation. Clin Chest Med, 2017, 38(4): 641-654.
37. Liu Y, Liu Y, Su L, et al. Recipient-related clinical risk factors for primary graft dysfunction after lung transplantation: A systematic review and meta-analysis. PLoS One, 2014, 9(3): e92773.
38. Fernandez R, Chiu S, Raparia K, et al. Humoral human lung allograft rejection by tissue-restricted non-HLA antibodies. Ann Thorac Surg, 2016, 102(4): e339-e341.
39. Whited WM, Henley P, Schumer EM, et al. Does donor age and double versus single lung transplant affect survival of young recipients?. Ann Thorac Surg, 2018, 105(1): 235-241.
40. Salamo O, Roghaee S, Schweitzer MD, et al. White donor, younger donor and double lung transplant are associated with better survival in sarcoidosis patients. Sci Rep, 2018, 8(1): 6968.

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Latest ArticlesSingle versus bilateral lung transplantation in end-stage chronic obstructive pulmonary disease: A systematic review and meta-analysis

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