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Lung Function after Transplantation: Two Lungs Are Better than One
D. P. Mason, J. Rajeswaran, S. C. Murthy, A. M. McNeill, M. M. Budev, A. C. Mehta, G. B. Pettersson, E. H. Blackstone. Cleveland Clinic Foundation, Cleveland, OH 44195, OH,
BACKGROUND:
The value of double versus single lung transplantation (LTx) remains debated. We sought to 1) determine whether double LTx produces improved lung function, as reflected in spirometry, over single LTx, and 2) identify predictors of higher and lower function.
METHODS:
From our program’s inception in 2/1990 until 11/2005, 463 adult patients underwent LTx. Preoperative and postoperative normalized FEV1 and FVC were evaluated, with 6,372 records available for 379 patients (82% of the population). Using longitudinal temporal decomposition analysis for continuous measurements, we analyzed the time course of postoperative spirometry, compared it between double and single LTx, and identified modulators of the temporal pattern.
RESULTS:
FEV1 (% of predicted) for double LTx was better than for single lungs (65, 58, and 59 vs 51, 43, and 40 at 1, 3, and 5 years, P=.03). FVC (% of predicted) for double LTx was also better than for single LTx (67, 68, and 66 vs 62, 56, and 51, P<.0001). For double LTx, temporal pattern for both FEV1% and FVC% showed a sharp increase up to 1 year followed by a slight decrease, with relative constancy to 5 years (Fig). For single LTx, there was also a sharp increase in FEV1% and FVC% to 1 year; however, this was followed by a sharp and continuous decrease to 5 years. Values for double LTx remained higher than for single LTx at all time points. Older recipient age and smaller age difference between donor and recipient were associated with higher FEV1%. Patients undergoing double LTx for emphysema had the highest postoperative FEV1% and FVC% but also the lowest FEV1% and FVC% for single LTx; other diagnoses showed benefit of double LTx that was between these values.
CONCLUSIONS:
Patients undergoing double LTx demonstrate better lung function than those undergoing single LTx, although it does not reach normal levels. Lung function is also better preserved after double LTx. 
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