• Yuriko Terada, Tsuyoshi Takahashi, Ramsey R Hachem, Jingxia Liu, Chad A Witt, Derek E Byers, GuillametRodrigo VazquezRVDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Mo., Hrishikesh S Kulkarni, Ruben G Nava, Benjamin D Kozower, Bryan F Meyers, Michael K Pasque, G Alexander Patterson, Daniel Kreisel, and Varun Puri.
• Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo. Electronic address: yterada@wustl.edu.
• J. Thorac. Cardiovasc. Surg. 2022 Dec 1; 164 (6): 16501659.e31650-1659.e3.

ObjectiveThe decision to perform single lung transplants or double lung transplants is usually made before the operation. We have previously reported that a proportion of single lung transplants were unexpectedly performed in the setting of an aborted double lung transplant, and these patients may be at a higher risk of worse short-term outcomes. Long-term outcomes in unplanned single lung transplants remain unknown.MethodsWe analyzed a single-center database of lung transplants from 2000 to 2020. Single lung transplants were classified into planned and unplanned groups after reviewing operative notes. Root cause analysis was performed for unplanned single lung transplants.ResultsOf the 1326 lung transplants, 1265 (95%) were double lung transplants and 61 (5%) were single lung transplants (22 planned [36%], 39 unplanned [64%]). Underlying indications for transplant were significantly different; planned single lung transplant: chronic obstructive pulmonary disease (55%) and idiopathic pulmonary fibrosis (45%); unplanned single lung transplants: chronic obstructive pulmonary disease (23%), idiopathic pulmonary fibrosis (39%), and bronchiolitis obliterans syndrome (13%). The primary reasons for unplanned single lung transplant were donor-related (3, 7.7%), recipient-related (31, 80%), and donor and recipient-related factors (5, 13%). Unplanned single lung transplants were more likely to require cardiopulmonary bypass during the operation (planned: 4/22, 18% vs unplanned: 20/39, 51%) but had shorter ischemic times (planned: 251 ± 58 minutes vs unplanned: 221 ± 48 minutes). The 5-year overall survival was 53% in the planned and 58% in the unplanned groups, respectively (P = .323). No difference in chronic lung allograft dysfunction-free survival (P = .995) was observed.ConclusionsUnplanned single lung transplants in the setting of aborted double lung transplant may be associated with acceptable long-term outcomes.Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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