Significantly Reduced Patient and Graft Survival for Left Versus Right Donor Lungs for Lung Transplant Recipients

Purpose To evaluate the association of right versus left single lung transplants (SLT) from split lung donors with long-term post-transplant recipient outcomes. Methods We performed a retrospective review of the Scientific Registry of Transplant Recipients data of split SLT adult recipients comparing right and left lung grafts between 2005-2021. We used a paired donor model to account for underlying differences between donors and evaluated post-transplant patient and graft survival with Cox proportional hazard models with robust variance estimates adjusted for recipient characteristics. We also used Wilcoxon signed rank, McNemar’s, and Bowker’s tests to evaluate complication rates between donor pairs. Results There were 5,180 recipients with 2,590 right and left split allografts. Left SLT had higher rates of mortality (HR=1.17, 95%CI:1.08,1.27) and graft failure (HR=1.16, 95%CI:1.06,1.26) compared to right SLT in adjusted models. There were more early deaths (<13 days post-transplant) among left vs. right SLT (n=52 vs 31, p=0.018). Estimated 5-year graft survival was 47.1% (95%CI:45.1,49.3) and 51.4% (95%CI:49.4,53.5) for left and right SLT, respectively. Right SLT was associated with longer length of stay (median 14 days vs 13 days, p=0.016) and more prolonged ventilation (>5 days) (n=319, 12.6% vs n=270, 10.6%; p=0.030). Conclusion Left SLT was associated with significantly worse mortality and graft failure while right SLT was associated with more short-term complications from split lung donors. Organ listing and acceptance decisions should consider donor lung laterality.