Both unilateral and bilateral lung transplantation in chronic obstructive pulmonary disease (COPD) can improve pulmonary function, exercise capacity and quality of life; however, whether lung transplantation actually improves survival is debated.

In this study, survival after transplantation of one or two lungs in end-stage COPD in nearly 10 000 patients in the International Society for Heart and Lung Transplantation (ISHLT) registry was compared. This observational study included all reported lung transplantations worldwide from inception of the registry in 1987 until 2006. Median survival time after bilateral lung transplantation (6.41 years) was better than after unilateral procedures (4.59 years). However, bilateral lung transplantation had little benefit compared with unilateral transplantation for patients aged ⩾60 years.

Lung transplants are very limited in supply and therefore more concentration on preventing the disease through smoking prevention programmes and other conventional treatments beside lung volume reduction, either surgically or with bronchoscopic placement of one-way endobronchial valves, may still be a better option. Although rigorous application of sophisticated statistical methods was applied to adjust for baseline differences, unmeasured differences might exist between recipients of unilateral and bilateral transplants and only a randomised controlled trial will remove all possible confounders.

▸ Thabut G, Christie JD, Ravaud P, et al. Survival after bilateral versus single lung transplantation for patients with chronic obstructive pulmonary disease: a retrospective analysis of registry data. Lancet 2008;371:744–51.