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Background: Single lung transplantation (SLT) has been shown to be associated with worse long-term outcomes than bilateral lung transplantation (BLT), but often is performed in older adults at risk of not tolerating BLT.

Research question: How do the outcomes of SLT and BLT compare among older adult recipients?

Study design and methods: The Scientific Registry of Transplant Recipients database (2005-2022) was queried for lung transplant recipients aged 65 years older. Patients were stratified by whether they underwent BLT or SLT and were propensity matched. Baseline characteristics and morbidity were compared with frequentist statistics. Survival was analyzed via Kaplan-Meier estimation. Risk factors for mortality were identified with Cox regression.

Results: Of 9,904 included patients, 4,829 patients (48.8%) underwent SLT. Patients who underwent SLT had lower lung allocation scores (39.6 vs 40.6; P < .001), more interstitial lung disease (74.4% vs 64.6%; P < .001), and lower rates of bridging (0.7% vs 2.4%; P < .001). Groups did not differ significantly by sex, BMI, or donor characteristics. Propensity matching resulted in 2,539 patients in each group. On matched analysis, patients undergoing SLT had shorter lengths of stay (14 days vs 18 day), lower reintubation rates (14.7% vs 19.8%), and less postoperative dialysis use (4.2% vs 6.4%; P < .001 for all). Patients who underwent SLT had comparable survival at 30 days (97.6% vs 97.3%; P = .414) and 1 year (85.5% vs 86.3%; P = .496), but lower survival at 5 years (45.4% vs 53.4%; P < .001) on matched analysis. SLT was a risk factor for 5-year mortality (adjusted hazard ratio, 1.19; P < .001).

Interpretation: Our findings show that in older adults, SLT is associated with less morbidity and comparable early survival relative to BLT, but lower 5-year survival. This suggests that SLT is reasonable to perform in older adults at high risk of not tolerating BLT.

Background: Accurate spirometry interpretation is critical in the diagnosis and management of COPD. With increasing efforts for a unified approach by the Global Lung Function Initiative (GLI), this study evaluated the application of race-specific 2012 GLI and race-neutral 2022 GLI reference equations compared with Choi's reference equations, which are derived and widely used in South Korea, for spirometry interpretation in Northeast Asian patients with COPD.

Research question: What are the effects of applying race-specific 2012 GLI, race-neutral 2022 GLI, and Choi's reference equations on the diagnosis, severity grade, and clinical outcome associations of COPD?

Study design and methods: Serial spirometry data from the Korea COPD Subgroup Study (KOCOSS) consisting of 3,477 patients were used for reanalysis using 2012 GLI, 2022 GLI, and Choi's reference equations. The COPD diagnosis and severity categorization, associations with disease manifestations and health outcomes, and longitudinal trajectories of lung function were determined.

Results: Although there was strong concordance in COPD diagnosis comparing 2012 GLI, and 2022 GLI reference equations with Choi's reference equations, a notable portion of patients were reclassified to milder disease severity (17.0% and 23.4% for 2012 GLI and 2022 GLI reference equations, respectively). Relationships between FEV₁ % predicted values calculated using 2012 GLI, 2022 GLI, and Choi's equations with clinical outcomes including dyspnea severity, exercise capacity, health-related quality of life, and frequency of exacerbations remain consistently significant. Similar annual decline rates of FEV₁ and FVC % predicted were observed among the reference equations used, except for slower annual decline rate of FEV₁ in Choi's equation compared with 2022 GLI race-neutral equation.

Interpretation: Application of GLI reference equations for spirometry interpretation in Northeast Asian patients with COPD has potential implications on disease severity grade for clinical management and trial participation, and maintains consistent significant relationships with key disease outcomes.

Case presentation: A 56-year-old woman was admitted to our hospital, presenting with a history of recurrent fevers persisting for over 2 months. The febrile episode was self-limiting, accompanied by cough without significant expectoration, with the fever predominantly manifesting during the afternoon and evening hours. Furthermore, there were no concurrent symptoms indicative of chest tightness, wheezing, dyspnea, or hemoptysis. A CT scan in a local hospital demonstrated multifocal lymphadenopathy in the mediastinum and bilateral supraclavicular regions. The patient had neither a history of tobacco usage nor of alcohol consumption. Furthermore, there was no familial history of oncologic conditions. The patient's medical records revealed no evidence of hypertension, diabetes mellitus, coronary artery disease, infectious diseases, or immunologic disorders.