Bilateral lung transplantation in severe chest asymmetry

Suppurative lung diseases leading to end-stage respiratory failure are typical indications for bilateral lung transplantation. Some cases may present severe chest asymmetry because of recurrent infections or previous surgical therapies, especially in patients with cystic fibrosis. To deal with this anatomical condition, the most used surgical options are single lung transplantation with contralateral pneumonectomy or bilateral transplantation with graft downsizing. T We reviewed the clinical data of patients with significant pleural cavities asymmetry who received bilateral lung transplantation at our center from 2017 to 2022. Clinical reports of all patients who underwent lung transplantation for end-stage suppurative lung disease in the same period were revised as control group. During the study period, 74 patients underwent bilateral lung transplantation for suppurative disease; 7 of them presented severe thorax asymmetry. All patients in chest asymmetry group were extubated within the second postoperative day. Mean intensive care unit stay was 4 days. Postoperative radiological evaluation did not show clustering or atelectasis of graft implanted in the smaller hemithorax. No perioperative major complications were recorded, and the average length of hospital stay was 23 days. Peri-operative course appeared remarkably good and both short and long-term follow-up prove to be entirely similar to the reference population. Bilateral lung transplantation in patients with severe chest asymmetry was feasible even without graft downsizing and could be considered as first option. In our experience, short- and medium-term results are not dissimilar to those obtained in patients without this serious problem of symmetry.