Medical Health Articles

Two New Lungs Might Be Better Than One

Researchers in France and the US have concluded that for youngerpatients in the final stages of chronic obstructive pulmonary disease(COPD), survival is lengthened by transplanting both lungs compared toonly one lung. The study, performed by Dr Gabriel Thabut, Service dePneumologie B et transplantation pulmonaire, H?pital Bichat, Paris,France, and colleagues, is published in the journal The Lancet.

COPD includes several diseases that limit airflow to the lungs, such aschronic bronchitis and emphysema, for example. Often, patients withend-stage lung diseases such as COPD can benefit most from lungtransplantation. About 46% of lung transplants were performed in orderto treat COPD from 1995 to 2007. This statistic includes both singleand bilateral (both lung) transplantation, and the focus of thiscurrent research is to see which procedure leads to longer survival.

The researchers used data from the registry of the InternationalSociety for Heart and Lung Transplantation. Of 9,883 COPD patientsbetween 1987 and 2007, 3,525 (35.7%) had bilateral lung transplantation(BLT) and 6,358 (64.3%) received single lung transplantation (SLT).

The median survival time after BLT was 6.41 years compared to 4.59years for SLT patients. Thabut and colleagues used various statisticalmethods to control for pre-transplant characteristics, and with eachmethod BLT continued to be associated with longer survival times thanSLT.

“Bilateral lung transplantation leads to longer survival than singlelung transplantation in patients with COPD, especially those who areyounger than 60 years…Any potential survival benefit of bilaterallung transplantation for individuals with COPD must be weighed againstthe potential societal benefits of allocation of organs to patientswith advanced lung diseases,” note Thabut and colleagues.

For patients 60 years and older, the researchers found that BLT onlyhad a small benefit in survival time compared to SLT. In addition, theresearchers analyzed results with respect to time period. Patients whohad an operation before 1998 had shorter survival times than those whohad one after 1998 - median time of 4.5 years (pre-1998) compared to5.3 years (post-1998).

An accompanying Comment by Dr E Clinton Lawrence, McKelvey Center forLung Transplantation and Pulmonary Vascular Diseases, Emory UniversitySchool of Medicine, Atlanta, GA, USA suggests that rather than lungtransplantation, doctors and patients should consider options such as:surgical lung-volume reduction, use of endobronchial valves, lungrehabilitation, and programs to quit smoking.

He writes: “Lung transplantation is an imperfect solution for COPD andother diseases, with a 5-year survival rate of about 50%. There is alimited supply of organs suitable for transplantation and patients,usually not those with COPD, die on waiting lists. Diminution of demandthrough smoking-prevention programmes is a far better alternative tolung transplantation.”

Survival after bilateral versus single lungtransplantation for patients with chronic obstructive pulmonarydisease: a retrospective analysis of registry data
Dr Gabriel Thabut MD, Jason D Christie MD, Prof PhilippeRavaud MD, Yves Castier MD, Olivier Brugière MD, Prof Michel FournierMD, Prof Hervé Mal MD, Prof Guy Lesèche MD, and Rapha?l Porcher PhD
The Lancet(2008). 371:744-751
doi:10.1016/S0140-6736(08)60344-X
ClickHere to View Abstract

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