Single vs double lung transplant survival outcomes in patients with COPD

A. Ashton. Manoni¹, M. Abul. Kashem², M. Warnick³, R. Yanagida⁴, K. Krishan⁵, H. Kehara², E. Leotta², N. Shigemura⁶, Y. Toyoda^7
1Lewis Katz School of Medicine at Temple University, Division of Cardiovascular Surgery, Philadelphia, Pennsylvania ²Department of Cardiothoracic Surgery at Temple University Hospital, Philadelphia, Pennsylvania ³Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania ⁴Temple University, Livingston, New Jersey ⁵Temple University, Philadelphia, Pennsylvania ⁶Temple University Hospital, Philadelphia, Pennsylvania ⁷Temple University Hospital, Philadelphia, Pennsylvania

Purpose: In COPD patients, double lung transplant (DLT) is increasingly used to prevent negative outcomes. Lung availability is limited, and some studies have shown no significant difference in survival outcomes between DLT and single lung transplant (SLT). Our purpose is to compare survival outcomes in COPD patients post SLT and DLT.

Methods: A single-center retrospective analysis was performed with 308 COPD patients over 18 years old who received a lung transplant between April 2012 and June 2023. Heart-lung transplantations and re-transplantations were excluded. Of the 308 patients considered, 115 received a DLT, and 193 patients received a SLT. Statistical tests were done with JMP Pro Version 17 using variables including age, sex, race, height, BMI, lung allocation score (LAS), and length of hospital stay (LOS). Survival outcomes based on type of transplant received were compared using Kaplan-Meier (K-M) survival analysis and log-rank tests. P-value < 0.05 was considered significant.

Results: Demographics data are shown in Table 1. Mean LAS for DLT recipients was 38 ± 11, and 33 ± 2 for SLT recipients. Survival analysis demonstrated no significant difference in 90-day or 1-year survival outcome between DLT and SLT recipients (p=0.801, p=0.317, respectively). However, survival outcomes trended towards significance, and at 3-years post-transplant, DLT was associated with a higher likelihood of survival (p=0.046). At this 3-year mark, Cox regression demonstrated that SLT was associated with increased mortality risk compared to DLT (p=0.041). By 5-years post-transplant, p-values showed there was no longer a significant difference in survival outcomes between DLT and SLT recipients (p=0.076, Image 1).

Conclusion: Although K-M survival curves separated around 3-years post-transplant in terms of significance, survival outcomes at 5-years post-transplant showed the gap is reduced over time. There is no significant difference between survival outcomes in patients who received SLT vs. DLT in a single center setting 5-years post-transplant.

Identify the source of the funding for this research project: Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA