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Two New Lungs Might Be Better Than One
Researchers in France and the US have concluded that for younger
patients in the final stages of chronic obstructive pulmonary disease
(COPD), survival is lengthened by transplanting both lungs compared to
only one lung. The study, performed by Dr Gabriel Thabut, Service de
Pneumologie B et transplantation pulmonaire, Hôpital Bichat, Paris,
France, and colleagues, is published in the journal The Lancet.
COPD includes several diseases that limit airflow to the lungs, such as
chronic bronchitis and emphysema, for example. Often, patients with
end-stage lung diseases such as COPD can benefit most from lung
transplantation. About 46% of lung transplants were performed in order
to treat COPD from 1995 to 2006. This statistic includes both single
and bilateral (both lung) transplantation, and the focus of this
current research is to see which procedure leads to longer survival.
The researchers used data from the registry of the International
Society for Heart and Lung Transplantation. Of 9,883 COPD patients
between 1987 and 2006, 3,525 (35.7%) had bilateral lung transplantation
(BLT) and 6,358 (64.3%) received single lung transplantation (SLT).
The median survival time after BLT was 6.41 years compared to 4.59
years for SLT patients. Thabut and colleagues used various statistical
methods to control for pre-transplant characteristics, and with each
method BLT continued to be associated with longer survival times than
SLT.
"Bilateral lung transplantation leads to longer survival than single
lung transplantation in patients with COPD, especially those who are
younger than 60 years...Any potential survival benefit of bilateral
lung transplantation for individuals with COPD must be weighed against
the potential societal benefits of allocation of organs to patients
with advanced lung diseases," note Thabut and colleagues.
For patients 60 years and older, the researchers found that BLT only
had a small benefit in survival time compared to SLT. In addition, the
researchers analyzed results with respect to time period. Patients who
had an operation before 1998 had shorter survival times than those who
had one after 1998 - median time of 4.5 years (pre-1998) compared to
5.3 years (post-1998).
An accompanying Comment by Dr E Clinton Lawrence, McKelvey Center for
Lung Transplantation and Pulmonary Vascular Diseases, Emory University
School of Medicine, Atlanta, GA, USA suggests that rather than lung
transplantation, doctors and patients should consider options such as:
surgical lung-volume reduction, use of endobronchial valves, lung
rehabilitation, and programs to quit smoking.
He writes: "Lung transplantation is an imperfect solution for COPD and
other diseases, with a 5-year survival rate of about 50%. There is a
limited supply of organs suitable for transplantation and patients,
usually not those with COPD, die on waiting lists. Diminution of demand
through smoking-prevention programmes is a far better alternative to
lung transplantation."
Survival after bilateral versus single lung
transplantation for patients with chronic obstructive pulmonary
disease: a retrospective analysis of registry data
Dr Gabriel Thabut MD, Jason D Christie MD, Prof Philippe
Ravaud MD, Yves Castier MD, Olivier Brugière MD, Prof Michel Fournier
MD, Prof Hervé Mal MD, Prof Guy Lesèche MD, and Raphaël Porcher PhD
The Lancet
(2008). 371:744-751
doi:10.1016/S0140-6736(08)60344-X
Click
Here to View Abstract
Written by: Peter M Crosta
Copyright: Start Sanatate
Not to be reproduced without permission of Start Sanatate
Douã noi plãmâni ar putea fi mai bine decât unul - Two New Lungs Might Be Better Than One - articole medicale engleza - startsanatate