A. A. Manoni1, M. Kashem1, K. Krishan1, R. Yanigada1, H. Kehara1, E. Leotta1, N. Shigemura1, Y. Toyoda1 1Lewis Katz School of Medicine at Temple University, Division Of Cardiovascular Surgery, Philadelphia, PA, USA
Introduction: In chronic obstructive pulmonary disease (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. Additionally, we looked at Pulmonary Function Test (PFT) results to see if Forced Expiratory Volume in the first second (FEV1) values could predict success of the transplant over time.
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), length of hospital stay (LOS), and PFT data. Survival outcomes based on type of transplant received and FEV1 scores in the first 3 months following transplant were compared using Kaplan-Meier (K-M) survival analysis and log-rank tests. A p-value < 0.05 was considered significant.
Results: Of the 115 DLT recipients, 80 (70%) were male. Of the 193 SLT recipients, 77 (40%) were male (p=0.0001). Mean age for DLT and SLT recipients were 63 ± 6 and 66 ± 6, respectively (p=0.0002). Mean LAS for DLT recipients was 37 ± 10, and 34 ± 3 for SLT recipients (p=.0001) Survival analysis showed no significant difference between DLT and SLT recipients in 90-days (p=0.801) or 1-year (p=0.317) post-transplant. At 5-years, there was no significant difference in survival outcomes between DLT and SLT recipients (p=0.076). FEV1 values in the first 3 months following transplant were used to analyze survival. Participants were grouped into FEV1 >80% or FEV1 <80%. In the 90 days post-transplant, there was no significant difference in survival between patients with FEV1 scores >80% and <80% (p=0.101). However, by 1 year post-transplant, there was a significant difference in survival between the two groups (p=0.019, Image 1).
Conclusion: K-M survival curves showed the gap in survival outcomes between SLT and DLT patients is reduced over time, and at 5-years post-transplant there is no significant difference in COPD patients' survival after lung transplantation. Immediately following transplant, patients with a FEV1 < 80% showed decreased survival chances compared to patients with a FEV1 > 80% at 1 year post-transplant, and the subsequent years.
