Single versus double lung transplantation in patients with pneumoconiosis: a retrospective cohort study

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BACKGROUND: Lung transplantation (LT) is emerging as a critical final treatment for end-stage lung diseases including pneumoconiosis. Outcomes of single lung transplantation (SLT) and double lung transplantation (DLT) in pneumoconiosis remain understudied. This study evaluates clinical differences between the two procedures in pneumoconiosis patients to guide therapeutic decision-making for this occupational population. METHODS: This retrospective cohort study included 119 pneumoconiosis patients undergoing LT at The Affiliated Wuxi People's Hospital of Nanjing Medical University between Jan 2018 and Dec 2022. The choice of SLT versus DLT was primarily driven by clinical judgment of high surgical risk, primarily due to severe pleural adhesions or calcification deemed too risky for bilateral pneumonectomy. Data on demographics, intraoperative and postoperative characteristics and patient survival were collected to compare SLT and DLT outcomes using Mann-Whitney U test and Pearson's chi-square test. The primary outcome was 1-year posttransplant survival. Posttransplant survival was assessed by Kaplan-Meier analysis and Cox proportional hazards models. RESULTS: Of all the transplant recipients, 61 (51.3%) underwent SLT and 58 (48.7%) underwent DLT. DLT recipients were younger (44 [33-51] vs. 49 [43-53], p = 0.012), had higher mean pulmonary pressure (25.0 [20.0-25.0] vs. 20.0 [15.0-25.0] mmHg, p = 0.005) and experienced longer ischemic time (16.1 [13.4-18.0] vs. 7.2 [6.2-8.5] hours, p < 0.001). The durations of intraoperative and postoperative extracorporeal membrane oxygenation (ECMO) were significantly longer in DLT recipients (p < 0.001; p = 0.003). The perioperative mortality of recipients who underwent SLT was more than three times higher than that of those undergoing DLT (18.0% vs. 5.2%, p = 0.059). Those who received DLT had significantly improved survival compared to SLT, with a hazard ratio of 0.24 (95% CI: 0.07-0.81, p = 0.022). CONCLUSION: Our preliminary data suggested that DLT might be associated with better survival in patients with pneumoconiosis compared to SLT. A randomized controlled trial or large-scale multicenter registry study is needed to confirm this survival benefit and refine patient selection criteria.

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