L. Weber Graeff1, S. Gonipati1, M. Azuma1, R.A. Castro1, K. Krishan1, H. Kehara1, R. Yanagida1, M.A. Kashem1, Y. Toyoda1 1Temple University, Division Of Cardiovascular Surgery, Philadelpha, PA, USA
Introduction:
COPD remains a major indication for lung transplants across the United States. Several studies have explored the outcomes of single versus double lung transplants in COPD patients with varying conclusions. Some studies find no difference in 5-year survival between the two groups while others indicate that DLTs may have better outcomes. In this study, we utilize the UNOS database to compare and analyze variables that may affect 5-year outcomes in single and double lung transplants in COPD patients to contribute to the current understanding of transplants in this population.
Methods:
Using transplant data from the UNOS database starting in January 1997 through March 2023, we obtained clinical variables from both single and double lung transplant patients with COPD (n = 12,478). Cohorts were defined as either single or double lung transplant recipients. No consideration was given to the stage/ severity of their COPD diagnosis. Analysis was performed on patient demographics, surgical variables and post-operative outcomes using the Student’s t and Chi-square tests for continuous and nominal variables, respectively. Survival at 5 years was analyzed with Kaplan-Meier and Log-rank tests and all analysis was completed on JMP Pro 17.0 software.
Results:
When stratifying by type of transplantation, we found that donor age (p < 0.001), gender match (p < 0.001), recipient BMI (p < 0.001), donor BMI (p < 0.001), recipient ethnicity (p < 0.001), donor ethnicity (p = 0.0092), LAS (p < 0.001), treatment with ECMO during the transplant (p = 0.0004), total ischemic time (p <0.001), LOS (p <0.001), treatment with ECMO at 72 hours (p <0.001), need for dialysis prior to discharge (p <0.001), and airway dehiscence prior to discharge (p <0.001) were found to be statistically different between the two groups. Recipient age (p = 0.337), donor gender (p = 0.521), and use of CPB during the transplant (p = 0.151) were not statistically different between the two groups.
When analyzing survival between the two groups, the type of lung transplant was significantly correlated with 5-year survival (p < 0.001), with DLT recipients experiencing higher levels of survival (66% survival at 5 years for DLTs and 52% survival at 5 years for SLTs).
Conclusion:
The results of this analysis contribute to the idea that COPD patients that receive DLTs experience better outcomes than patients who receive only a SLT. A possible explanation of this can come from considering the hemodynamics of lung transplants in COPD patients: perhaps the retention of the native lung in its hyper-inflated state may interfere with the ventilation and perfusion of the newly transplanted lung, contributing to the increased mortality seen.