Single versus Double Lung Transplantation for Chronic Obstructive Lung Disease(COPD)

Purpose Although COPD patients account for a large proportion of lung transplants, whether double lung transplantation (DLT) versus single (SLT) improves survival for COPD patients is not well established. Methods We identified 4521 COPD patients in the United Network for Organ Sharing (UNOS) database transplanted between May 2005 and August 2016. 604 patients assigned to the rehabilitation arm of the National Emphysema Treatment Trial (NETT), to receive only pulmonary rehabilitation and standard medical management, served as a control group. After trimming the UNOS population for NETT eligibility criteria, 539 UNOS single lung transplant recipients, 802 UNOS double lung transplant recipients and 604 NETT patients remained. Starting at transplantation time for UNOS patients, and randomization time for NETT patients, Kaplan-Meier estimates of subsequent transplant-free survival were compared between the matched UNOS SLT (n=183) and NETT (n=183); matched UNOS DLT (n =193) and NETT (n=193); UNOS SLT (n=529) and UNOS DLT (n=529). Results The median survival time for the trimmed samples was 5.1 years (IQR=0.8) for NETT, 4.8 years (IQR=1.3) for UNOS SLT, and 6.0 years (IQR=1.3) for UNOS DLT. In propensity-matched analyses, transplanted patients in UNOS SLT had better survival compared to medically managed patients in NETT (p=0.005); UNOS DLT had better survival compared to NETT (p=0.001) and median survival for UNOS DLT was 6.0 years and UNOS SLT was 5.5 years, a difference that was not statistically significant (p=0.1). Conclusion Both SLT and DLT lead to longer survival time compared to pulmonary rehabilitation and standard medical treatment. DLT may not offer better survival compared to SLT. Although COPD patients account for a large proportion of lung transplants, whether double lung transplantation (DLT) versus single (SLT) improves survival for COPD patients is not well established. We identified 4521 COPD patients in the United Network for Organ Sharing (UNOS) database transplanted between May 2005 and August 2016. 604 patients assigned to the rehabilitation arm of the National Emphysema Treatment Trial (NETT), to receive only pulmonary rehabilitation and standard medical management, served as a control group. After trimming the UNOS population for NETT eligibility criteria, 539 UNOS single lung transplant recipients, 802 UNOS double lung transplant recipients and 604 NETT patients remained. Starting at transplantation time for UNOS patients, and randomization time for NETT patients, Kaplan-Meier estimates of subsequent transplant-free survival were compared between the matched UNOS SLT (n=183) and NETT (n=183); matched UNOS DLT (n =193) and NETT (n=193); UNOS SLT (n=529) and UNOS DLT (n=529). The median survival time for the trimmed samples was 5.1 years (IQR=0.8) for NETT, 4.8 years (IQR=1.3) for UNOS SLT, and 6.0 years (IQR=1.3) for UNOS DLT. In propensity-matched analyses, transplanted patients in UNOS SLT had better survival compared to medically managed patients in NETT (p=0.005); UNOS DLT had better survival compared to NETT (p=0.001) and median survival for UNOS DLT was 6.0 years and UNOS SLT was 5.5 years, a difference that was not statistically significant (p=0.1). Both SLT and DLT lead to longer survival time compared to pulmonary rehabilitation and standard medical treatment. DLT may not offer better survival compared to SLT.