Double lung transplants better than single for long term survival


A study by a team of transplant surgeons at Johns Hopkins has shown that having both lungs replaced instead of just one is the single most important feature determining who lives longest after having a lung transplant, more than doubling an organ recipient's chances of extending their life by over a decade.

This is a potentially controversial finding as there is already a shortage of organ donors and more widespread use of bilateral lung transplants could nearly halve the potential number of beneficiaries.

However: "Not all lung recipients necessarily need a bilateral transplant" says study senior investigator and transplant surgeon Ashish Shah, MD. Many people with chronic obstructive pulmonary disease, including emphysema and different kinds of pulmonary fibrosis, can survive with just one lung being replaced, while other lung diseases, such as cystic fibrosis, usually require transplantation of both lungs."

Among the team's other key findings are that a perfect or near perfect match between the donor's immune-activating protein antigens with a recipient's and having a college education increases chances for long-term survival by 38% and 40%, respectively.

However, lead study investigator Eric Weiss, MD, says that a patient's education, though key, is more likely to be masking some other factor or combination of factors that are accounting for the increased longevity. Such factors could include better health insurance and access to care than those with less formal schooling, or that people with degrees are better at keeping their physician appointments on schedule, taking their medications as prescribed and sooner alerting their physicians to problems.

Weiss also points out that a key advantage in double-lung transplants over single-lung transplants is that residual disease is not left behind in the spared lung. Moreover, when both lungs are replaced, the new lungs, which must breathe together as a pair, are already adapted to each other.

This article was written by Breda Cronin, Associate – Industrial Disease Team.

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