Significantly reduced patient and graft survival for left vs right donor lungs for lung transplant recipients
Sarah Y. Park, MD,
Elizabeth Bashian, MD,
Navin Vigneshwar, MD,
Elizabeth A. David, MD, MAS,
Simran K. Randhawa, MBBS,
Robert A. Meguid, MD, MPH,
John D. Mitchell, MD,
Alice L. Gray, MD,
Susana Arrigain, MA,
Elizabeth A. Pomfret, MD, PhD,
Jesse D. Schold, PhD,
Michael T. Cain, MD,
Jordan R.H. Hoffman, MD, MPH
Affiliations
Sarah Y. Park, MD
Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Corresponding author: Sarah Y. Park, MD, Mail Stop C310, 12631 East 17th Avenue, Room 6602, Aurora, CO 80045.
Elizabeth Bashian, MD
Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Navin Vigneshwar, MD
Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina
Elizabeth A. David, MD, MAS
Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Simran K. Randhawa, MBBS
Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Robert A. Meguid, MD, MPH
Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
John D. Mitchell, MD
Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Alice L. Gray, MD
Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Susana Arrigain, MA
Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado
Elizabeth A. Pomfret, MD, PhD
Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado
Jesse D. Schold, PhD
Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado; Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Michael T. Cain, MD
Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Jordan R.H. Hoffman, MD, MPH
Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Background: To evaluate the association of right vs left single lung transplants (SLT) from split lung donors with long-term post-transplant recipient outcomes. Methods: We performed a retrospective review of the Scientific Registry of Transplant Recipients data of split SLT adult recipients comparing right and left lung grafts between 2005 and 2021. We used a paired donor model to account for underlying differences between donors and evaluated post-transplant patient and graft survival with Cox proportional hazard models with robust variance estimates adjusted for recipient characteristics. We also used Wilcoxon signed-rank, McNemar’s, and Bowker’s tests to evaluate complication rates between donor pairs. Results: There were 5,180 recipients with 2,590 right and left split allografts. Left SLT had higher rates of mortality (hazards ratio [HR] = 1.17, 95% confidence interval [CI]: 1.08, 1.27) and graft failure (HR = 1.16, 95% CI: 1.06, 1.26) compared to right SLT in adjusted models. There were more early deaths (5 days) (n = 319, 12.6% vs n = 270, 10.6%; p = 0.030). Conclusions: Left SLT was associated with significantly worse mortality and graft failure while right SLT was associated with more short-term complications from split lung donors. Organ listing and acceptance decisions should consider donor lung laterality.
