Single versus double lung transplantation for fibrotic disease—systematic review

Background: Lung transplantation has long been the accepted therapy for end-stage pulmonary fibrotic disease. Presently, there exists an ongoing debate over whether single or bilateral transplantation is the most appropriate treatment for end-stage disease, with a paucity of high-quality evidence comparing the two approaches head-to-head.
Methods: This review was performed in accordance with PRISMA recommendations and guidance. Searches were performed on PubMed Central, Scopus and Medline from dates of database inception to September 2019. For the assessed papers, data was extracted from the reviewed text, tables and figures, by two independent authors. Estimated survival over time was analyzed using the Kaplan-Meier method in studies where time-to-event data was provided.
Results: Overall, 4,212 unique records with 5,601 total patients were identified from the literature search. Following initial screening and the addition of reference list findings, 83 full-text articles were assessed for eligibility, of which 17 were included in the final analysis. Kaplan-Meier survival analysis illustrated superiority of bilateral lung transplantation (BLTx) for idiopathic pulmonary fibrosis (IPF) over single lung transplantation (SLTx) at all time intervals, with aggregated survival for BLTx at 57%, 35.3% and 24% at 5-, 10- and 15-year follow-up, respectively. Survival rates for SLTx were 50%, 27.8% and 13.9%, respectively.
Conclusions: Whilst a number of studies present conflicting results with respect to short-term transplantation outcomes, the consensus is that BLTx confers improved long-term survival over that of SLTx, with large-scale registries supporting the findings from single- and multi-center studies. Through an aggregation of the present survival data existing in the literature, this meta-analysis identified superiority of BLTx over that of SLTx at all time intervals.