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Bilateral Lung Transplantation Provides Better Long-term Survival and Pulmonary Function Than Single Lung Transplantation

A Systematic Review and Meta-analysis

Yu, Haoda MM1; Bian, Tao PhD1; Yu, Zhen MM1; Wei, Yiping MD2; Xu, Jianjun PhD2; Zhu, JianRong MM1; Zhang, Wenxiong MD2

doi: 10.1097/TP.0000000000002841
Original Clinical Science—General

Background. Both bilateral lung transplantation (BLT) and single lung transplantation (SLT) are commonly used, but which method is better remains controversial. This meta-analysis was conducted to compare the 2 surgical procedures to identify a better clinical choice.

Methods. Cohort studies comparing SLT and BLT were identified by conducting searches of databases and screening references of retrieved articles. Survival, pulmonary function, surgical indicators, and complications were compared between the 2 groups.

Results. Thirty studies (1980 recipients in the SLT group and 2112 recipients in the BLT group) were pooled in the meta-analysis. The long-term overall survival rate (OSR) (OSR-4y and OSR-5y), bronchiolitis obliterans syndrome (BOS)–free survival, BOS-free survival rate (BFSR) (2–5 y), 6-minute walking distance, forced expiratory volume in 1 second (%), forced vital capacity (%), oxygenation index, pulmonary arterial pressure, Arterial partial pressure of oxygen (Pao2), diffusing capacity of the lung for carbon monoxide (Dlco), and BOS were better in the BLT group than in the SLT group. The advantages shown in the BLT group compared with the SLT group in regard to these variables increased with the prolongation of survival time. However, surgical time, ischemic time, postoperative intensive care unit days, and postoperative hospital days were shorter in the SLT group than in the BLT group. Overall survival, short-term OSR (1–3 y), BSFR-1y, in-hospital mortality, postoperative ventilator days, and postoperative complications (except BOS) were similar between the 2 groups. Bacterial pneumonia, graft failure, fungal infection, cardiac arrhythmia, and hemorrhage were the top 5 causes of in-hospital mortality.

Conclusions. BLT appears to be associated with better long-term survival, better postoperative lung function, and less BOS compared with SLT. In-hospital mortality and postoperative complications (except BOS) were similar between the 2 groups.

1 Department of Respiratory and Critical Care Medicine, Wuxi People’s Hospital affiliated to Nanjing Medical University, Wuxi, China.

2 Department of Thoracic Surgery, The second affiliated hospital of Nanchang University, Nanchang, China.

Received 28 February 2019. Revision received 17 May 2019.

Accepted 31 May 2019.

H.Y., J.R.Z., and W.Z. participated in research design. H.Y. and W.Z. participated in the writing of the paper. T.B., Z.Y., Y.W., and W.Z. participated in the performance of the research. H.Y. and J.X. contributed new reagents or analytic tools. H.Y. and W.Z. participated in data analysis.

The authors declare no conflicts of interest.

This study was supported by National Natural Science Foundation of China (NSFC, grant number 81560345).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Correspondence: JianRong Zhu, MD, Department of Pulmonary and Critical Care Medicine, Wuxi People’s Hospital affiliated to Nanjing Medical University, 299 Qingyang Rd, Wuxi, China, 214023. (

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