The choice of single or bilateral lung transplant for interstitial lung disease (ILD) is controversial as surgical risk, long term survival and organ allocation are competing factors. In an effort to balance risk and benefit, our center adopted a staged bilateral lung transplant approach for higher surgical risk ILD patients where the patient has a single lung transplant followed by a second single transplant at a later date. We sought to understand the surgical risk, organ allocation and early outcomes of these staged bilateral recipients as a group and in comparison to matched single and bilateral recipients. Our analysis demonstrates staged bilateral lung transplant recipients (n=12) have a higher LAS, lower pulmonary function tests and lower glomerular filtration rate prior to the first transplant compared to the second (p<0.01). There was a shorter length of hospital stay for the second transplant (p=0.02). The staged bilateral compared to single and bilateral case matched controls had comparable short-term survival (p=0.20) and pulmonary function tests at one year. There was a higher incidence of renal injury in the conventional bilateral group compared to the single and staged bilateral groups. The staged bilateral procedure is a viable option in select ILD patients.
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