EVALUATION OF THE LONG-TERM RESULTS OF SINGLE-LUNG VERSUS HEART-LUNG TRANSPLANTATION FOR EMPHYSEMA

Background: Heart and lung transplantation used to be the standard operation for patients with emphysema. Because of the shortage of donors, more patients are having single lung transplantation with satisfactory short-term results. Methods: This study was performed to evaluate the long-term results of both groups. During the period between December 1985 and December 1993, 89 patients underwent lung transplantation for emphysema; of these, 21 patients (14 male and 7 female) underwent heart-lung transplantation, and 68 patients (43 male and 25 female) underwent single lung transplantation. There were 31 right and 37 left single lung transplantations with 24 bronchial revascularization procedures. Results: The actuarial 5-year survival was 67% +/- 0.3% in single lung and 60% +/- 0.2% in heart-lung groups (p = 0.947). In the single lung group, two patients required a second single lung for air trapping and 11 patients (16%) had obliterative bronchiolitis, two of whom required retransplantation. In the heart-lung group, four patients (19%) had obliterative bronchiolitis, two of whom required retransplantation. The cumulative probability of developing obliterative bronchiolitis at 3 and 5 years was 17% and 38% in the heart-lung transplantation group and 23% and 48% in the single lung transplantation group, respectively. The average forced expiratory volumes in 1 second at 3 and 5 years were 1.6 and 1.4 (L/min) (standard error +/- 0.2 L/min) for single lung and 3 and 2.9 (L/min) (standard error +/- 0.25) for heart-lung transplant recipients, respectively. The percentage of the predicted maximum oxygen consumption was 42% and 58% in single lung and heart lung groups, respectively. Conclusions: The long-term results in respiratory function, exercise capacity, and the quality of life of heart-lung transplant recipients are significantly better with similar survival compared with single lung transplant recipients. Although single lung transplantation for patients with emphysema makes better use of organs, the long-term results when compared with those of the heart-lung group needs to be evaluated further.