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J Thorac Cardiovasc Surg 1998;115:485-486
© 1998 Mosby, Inc.

LETTERS TO THE EDITOR

Single or bilateral lung transplantation for chronic obstructive pulmonary disease

Catherine D. Sudarshan, FRCS, Stephen C. Clark, FRCS, John H. Dark, FRCS

To the Editor:

We read with interest the article by Bavaria and colleaguesGo 1 concerning bilateral (BLT) versus single (SLT) lung transplantation for chronic obstructive pulmonary disease (COPD) and would like to make the following comments:

The primary indication for transplantation in COPD is to relieve the patient's symptoms, not to improve longevity. It is therefore difficult to justify the use of a pair of lungs in patients with COPD when there is an ever-increasing and obligatory need for BLT in patients with cystic fibrosis.

We believe it is difficult to draw any comparison, because the groups differed demographically.

The mean ages of the two groups differed substantially, the BLT recipients being significantly younger (48.8 vs 55.3 years, p < 0.001). More than half of the BLT recipients were men, compared with less than a third of the SLT recipients (58.6% vs 27.7%: p = 0.007). There is sufficient data to show that patients less than 50 years of age have a significantly improved life expectancy and that being male gives one a better chance of survival than being female.Go 2 Finally, we were surprised that the authors could "favorably compare" their 28.3% 1-year mortality for the SLT recipients to the Washington University figure of 10.3%.Go 3 Indeed, survival figures from the Heart and Lung Transplant Registry indicate 1-year mortality for SLT and BLT to be 19.81% and 17.96%, respectively (p > 0.05).Go 2

Although we entirely agree that BLT would result in better pulmonary function, quality of life, and life expectancy, it is hard to justify the practice of BLT in patients with COPD, and confusion may occur when such figures are quoted without comparing two demographically similar groups.

Department of Cardiopulmonary TransplantationFreeman HospitalNewcastle upon Tyne NE7 7DN, United Kingdom[Response declined]

References

  1. Bavaria JE, Kotloff R, Palevsky H, Rosengard B, Roberts JR, Wahl PM, et al. Bilateral versus single lung transplantation for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg 1997;113:520-8.[Abstract/Free Full Text]
  2. Hosenpud JD, Novick RJ, Bennett LE, Keck BM, Fiol B, Daily OP. The Registry of the International Society for Heart and Lung Transplantation: Thirteenth Official Report—1996. J Heart Lung Transplant 1996;15:655-74.[Medline]
  3. Sundaresan RS, Shiraishi Y, Trulock EP, Manley J, Lynch J, Cooper JD, et al. Single or bilateral transplantation for emphysema? J Thorac Cardiovasc Surg 1996;112:1485-95.[Abstract/Free Full Text]




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