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Double-lung transplants better than single-lung, Hopkins study finds
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Lung transplant recipients who received two lungs are twice as likely to be alive ten years later than those who receive only one, researchers at the Johns Hopkins University School of Medicine have reported.
Dr. Ashish Shah, Surgical Director of the Hopkins Lung Transplantation Program and his colleagues analyzed the records of 890 lung transplant recipients and found that those who received two lungs were twice as likely to be alive ten years later than those who received only one.
In a telephone interview, Dr. Shah explained that the norm has usually been for patients with suppurating diseases (those associated with chronic infections) like cystic fibrosis, and those with pulmonary hypertension, to get both lungs replaced. Patients with ailments like emphysema or pulmonary fibrosis seemed to fare well enough with single-lung transplants. But standards and practices vary among different transplant centers, with some favoring single-lung transplants and other favoring double-lung transplants. “We’ve had enough patients over twenty years that we can ask the question, ‘Which is better?’” he said.
Dr. Shah did not foresee that the findings would greatly increase the waiting time for lung transplants. He stated that the number of patients waiting for a lung transplant has dropped dramatically with improved medical management of conditions such as pulmonary hypertension, and with the adoption in 2005 of a new system for allocating donor lungs. “At certain very aggressive transplant centers, the time on the wait list has really decreased,” he said. “For example, for different periods of time last year, Johns Hopkins would have only one or two people on our wait list, simply because we transplanted everybody that was waiting.”
He also did not foresee that the findings would lead to any changes in the near future in the rules for allocating lungs to potential recipients. “In truth, we still have a lot to learn about this operation.”
Dr. Shah also noted that one of the most significant factors predicting long-term survival of lung transplant patients was education. “We think a college education, which showed up pretty significant in this study, was just really a surrogate for either access to health care or people actually being attentive to care. One of the common mechanisms for people to die after a transplant is that they don’t take their medication.
“Not all patients, but many of them, just don’t feel great. They realize they’re alive, they feel better than they did before, but they never actually feel fantastic, and I actually think that wears on people.
“My hunch is that at least ten to fifteen percent of long-term deaths are related to non-compliance, non-adherence, social problems.
“It’s not that they all don’t feel great. I have many patients who feel wonderful, so it’s a mixed bag.”
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