Lung transplantation in idiopathic pulmonary fibrosis: one is (nearly) as good as two

Recommendations for double lung transplant (DLT) as a procedure of choice over single lung transplant (SLT) in idiopathic pulmonary fibrosis (IPF) are common but controversial. Ranganath et al (Ann Thorac Surg 2020;109:211) retrospectively collected data from the Scientific Registry of Transplant Recipients in the USA between 2007 and 2017. They reduced selection bias by including only patients with IPF who had been listed for both SLT and DLT simultaneously and used a 24 variable propensity matching system. SLT recipients had improved perioperative outcomes, requiring less prolonged post-transplant ventilatory support (31.6% vs 42.0%, p=0.001) and lower rates of postoperative dialysis (2.6% vs 5.0%, p=0.060) with a shorter length of hospital stay. There was no significant difference in patient survival at 1, 5 or 10 years (SLT vs DLT: 88% vs 88%; 57% vs 61%; 27% vs 24%), and no significant difference between acute rejection rates, bronchiolitis obliterans syndrome free survival and graft survival. The authors highlight the limitations of their study design while acknowledging the challenges of performing randomised trials in this field. They emphasise that the previously reported survival advantage of DLT over SLT in IPF may represent selection bias and acknowledge …