Description

Lung transplantation is a life-saving option for patients with end-stage lung diseases when all other treatments fail. Two primary surgical approaches exist—single-lung transplantation (SLT) and double-lung transplantation (DLT)—each with unique benefits, risks, and outcomes. Who benefits from which procedure? SLT is often considered for patients with localized conditions such as idiopathic pulmonary fibrosis (IPF) or in older patients where a shorter, less invasive surgery reduces immediate risks. In contrast, DLT is recommended for conditions involving both lungs, such as cystic fibrosis, pulmonary hypertension, and advanced emphysema, where replacing both lungs ensures better function and safety. Survival and outcomes Registry data suggest that DLT generally offers longer survival, with a median of 6.6–6.7 years compared to 4.6 years for SLT. In IPF, DLT provides clear advantages, with higher long-term survival rates—55% at 10 years versus 32% for SLT. For COPD, the survival difference is smaller, and in some cases SLT on the right lung yields comparable results. For pulmonary hypertension and cystic fibrosis, however, DLT delivers significantly superior survival, with studies reporting 5-year survival of 84% versus 51%. Functional recovery DLT recipients often experience greater improvements in lung function and exercise tolerance. Research shows longer six-minute walk distances and stronger lung volumes compared with SLT, translating into better quality of life. Advancements in techniques Recent milestones include the world’s first fully robotic DLT using the da Vinci Xi system, which reduced recovery burden, and the growing use of ex-vivo lung perfusion (EVLP) to recondition donor lungs once considered unsuitable. EVLP protocols can extend lung preservation up to 17 hours, improving donor availability and transplant outcomes. Surgical considerations SLT is shorter, less complex, and often chosen for patients at higher surgical risk. DLT, performed through clamshell or bilateral thoracotomy incisions, is more demanding but often delivers better long-term benefits. In summary, DLT is generally superior for patients with diffuse or bilateral disease, offering longer survival and better functional recovery. SLT remains valuable in select cases—particularly older patients or those with unilateral disease. With advances in surgical robotics and organ preservation, both approaches continue to evolve, bringing new hope to patients facing otherwise untreatable lung failure.