Results of “Twinning Procedure” in Lung Transplantation: Experience in a Single Center M. M. de la Torre, J. M Borro, R. Fernández, D. González, M. Delgado, M. Paradela, J.A. Garcı´a, and C. Lemos ABSTRACT Introduction. The major limiting factor for lung transplantation (LT), both worldwide and in Spain, is the number of suitable lung donors. This, together with the increased demand for LT, led us to propose the performance of 2 single lung transplantations simultaneously using the same donor (the “twinning procedure”). Objective. The objective of this study was to analyze the outcome of patients who underwent transplantation with this procedure, assessing differences between the first and the second transplant. Patients and Methods. From November 2001 to August 2008, 46 single lung transplan- tations (SLTs) were performed with 23 donors. Results. The mean ischemia time was 258 minutes (median, 265) for the first transplan- tation and 312 minutes (median, 320) for the second transplantation. Primary graft dysfunction occurred in 5 patients (24%) in the first group and 9 in the second group (39%; P = .27). The median intubation time was 8 hours for the first and 6.5 hours for the second group. The mean hospital stay was 39 and 31 days, respectively. Postoperative mortality was 2 (8.7%) and 3 (13%) patient, respectively (P = .99). There was no significant difference in the incidence of acute rejection episodes, infections, or chronic rejections. Five-year survival rates were 67.9% for the first and 61.5% for the second (Kaplan-Meier). Conclusions. The performance of 2 SLTs using the same donor and in the same hospital was feasible with adequate planning, permitting better use of donors and reducing waiting list time and mortality. Our results showed no increased risk for recipients of the second transplant in the early postoperative and long-term periods. T HE limited number of suitable lung donors, together with the progressive increase in the number of recip- ients on the waiting list, have led to new strategies to expand the donor pool and increase donor organ use. One of these, the “twinning procedure,” refers to lung allografts from the same donor to perform 2 single lung transplanta- tions (SLTs) in 2 recipients. 1 The fact that the 6 centers performing lung transplanta- tions (LT) in Spain are not too distant from each other has allowed donors to be shared between 2 hospitals, perform- ing 2 SLTs from the same donor on numerous occasions with good results, although outcomes were also determined by external factors specific to each center. 2 Our strategy was to take advantage of both lungs of a suitable donor assigned to our group for 2 recipients from our waiting list, provided that this was permitted by donor-recipient characteristics and hospital logistics. It was also necessary to reduce surgical times as much as possible so that both cases were performed within the permissible ischemia time. The objec- tive of this study was to analyze the outcome of this group of SLTs, confirming whether there were differences be- tween the first and second transplantation. From the Thoracic Surgery Department, Complexo Hospita- lario Universitario de A Coruña, Spain. Address reprint requests to M a Mercedes de la Torre, Servicio de Cirugı ´a Torácica, Complexo Hospitalario Universitario de A Coruña, Xubias de Arriba 84, 15006- A Coruña, Spain. E-mail: mtorre@canalejo.org © 2009 Published by Elsevier Inc. 0041-1345/09/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2009.05.018 Transplantation Proceedings, 41, 2213–2215 (2009) 2213