Correlation between stinging, TEWL and capacitance

Background/aims: To study the correlation between stinging and skin barrier and to make the lactic acid stinging test much safer.
Methods: The modified lactic acid stinging test with 3% and/or 5% aqueous solution of lactic acid combined with transepidermal water loss (TEWL) and capacitance (CAP) was used. The amount of 50 µL-test material was applied on test areas, the skin of both sides nasolabial fold of 50 healthy subjects. Subjects assessed stinging basing on a 4-point scale at 0, 2.5, 5.0 and 8 min TEWL and CAP were measured at baseline and 8 min.
Results: The results show that the tendency of decrease in baseline CAP and increase in baseline TEWL are proportional with the increase of the sum of clinical scores (CS_S) . In 5% lactic acid test, negative correlation between changing ratio of TEWL (P_TEWL) and clinical score at 5 min (CS_5 min), and negative correlation between changing ratio of capacitance (P_CAP) and CS_5 min are registered.
Conclusion : Our data indicate that there is certain relationship between the degree of stinging and the skin barrier. The stinging test method modified by lower concentration aqueous lactic acid and the assessment combined with P_TEWL and P_CAP is suitable for Chinese to evaluate the skin susceptibility.     

Comparison and correlation between stinging responses to lactic acid and bioengineering parameters

In evaluating the safety of a novel cosmetic product or a new chemical, it is important to assess susceptible population. One group of subjects is known to stingers who are more likely to experience sensory effects such as stinging and burning after contacting with cosmetics. The purpose of the study is to measure skin biophysical parameters noninvasively in stingers and non-stingers and to see their correlations with stinging responses. 298 women were evaluated by modified lactic acid stinging test with 5% lactic acid solution rather than classic 10% solution because of strong reaction in Asian populations. Transepidermal water loss (TEWL), skin hydration, sebum content, and pH were measured using the bioengineering instruments in an environment-controlled room. Correlations between stinging responses and skin biophysical parameters were statistically analysed. There was a positive correlation between stinging responses and TEWL evaluation. However, no correlations was observed between stinging responses and other parameters such as skin hydration, sebum content, and pH. Our data indicate that there is a relationship between the degree of stinging and the skin barrier function. However, we believe that various additional studies are necessary to characterize skin of stingers and the pathogenesis.     

Robotic-assisted laparoscopic partial nephrectomy: A comparison of approaches to the posterior renal mass

AIM: To evaluate outcomes of robotic-assisted laparoscopic partial nephrectomy performed for posterior renal tumors via a transperitoneal or retroperitoneal approach. METHODS: Retrospective review was performed for patients who underwent robotic-assisted laparoscopic partial nephrectomy (RALPN) for a posterior renal tumor between 2009-2015. Patient demographic characteristics, operative factors, pathology, oncologic outcomes, renal function, and tumor complexity were obtained. Radius of the tumor, exophytic/endophytic properties of the tumor, nearness of tumor to the collecting system, anterior/posterior position, location relative to the polar line (RENAL) nephrometry scores were calculated. nephrometry scores were calculated. The operative approach was determined by the primary surgeon. RESULTS: A total of 91 patients were identified who underwent RALPN for a posterior renal tumor. Fifty-four procedures were performed via the retroperitoneal (RP) approach, and 37 via the transperitoneal (TP) approach. There were no significant differences in patient factors (race, sex, age and body mass index), RENAL nephrometry scores, tumor size, conversion rates, or margin status. Among procedures performed on-clamp, there was no significant difference in warm ischemia times. Total operative time (180.7 min for RP vs 227.8 min for TP, P < 0.001), robotic console time (126.9 min for RP vs 164.3 min for TP, P < 0.001), and median estimated blood loss (32.5 mL for RP vs 150 mL for TP, P < 0.001) were significantly lower via the RP approach. Off-clamp RALPN was performed for 31 (57.4%) of RP procedures vs 9 (24.3%) of TP procedures. Oncologic and renal functional outcomes were equivalent. CONCLUSION: The RP approach to RALPN for posterior renal tumors is superior with regard to operative time and blood loss and the ability to be performed off-clamp.     

Noxious sensory perceptions in patients with mild to moderate rosacea treated with azelaic acid 15% gel

Patients with rosacea form a unique subset of the sensitive skin population because of the barrier defects inherent in this condition and the increased propensity for burning/stinging from topical products. This propensity for burning/ stinging when medications, skin care products, or cosmetics are applied to the facial skin has been frequently documented but never quantified. The objective of this 2-week study was to determine the prevalence of heightened neurosensory perceptions of burning/stinging in a random population of 40 women with mild to moderate rosacea defined as 15 or fewer inflammatory papules or pustules. Also evaluated was the effect of azelaic acid 15% gel on barrier function and facial stinging utilizing transepidermal water loss (TEWL), corneometry, and lactic acid facial sting tests as noninvasive measurement criteria. At baseline, the incidence of lactic acid stinging among these rosacea subjects was 62.5%, which is substantially higher than observed in the general population. Two weeks after application of azelaic acid 15% gel, no evidence of barrier damage was noted on TEWL or corneometry tests. Moreover, there was no statistical relationship between lactic acid stinging and a stinging response that is occasionally reported with exposure to azelaic acid 15% gel.     

1400W reduces ischemia reperfusion injury in an ex-vivo porcine model of the donation after circulatory death kidney donor

AIM: To investigate the effects of 1400W-a selective inducible nitric oxide synthase (iNOS) inhibitor in a model of donation after circulatory death (DCD) kidneys. METHODS: Porcine kidneys were retrieved after 25 min warm ischemia. They were then stored on ice for 18 h before being reperfused ex vivo with oxygenated autologous blood on an isolated organ perfusion system. The selective iNOS inhibitor 1400W (10 mg/kg) was administered before reperfusion (n = 6) vs control group (n = 7). Creatinine (1000 μmol/L) was added to the system, renal and tubular cell function and the level of ischemia reperfusion injury were assessed over 3 h of reperfusion using plasma, urine and tissue samples. RESULTS: Kidneys treated with 1400W had a higher level of creatinine clearance (CrCl) [area under the curve (AUC) CrCl: 2.37 ± 0.97 mL/min per 100 g vs 0.96 ± 0.32 mL/min per 100 g, P = 0.004] and urine output [Total: 320 ± 96 mL vs 156 ± 82 mL, P = 0.008]. There was no significant difference in levels of fractional excretion of sodium (AUC, Fr ex Na+: Control, 186.3% ± 81.7%.h vs 1400W, 153.4% ± 12.1%.h, P = 0.429). Levels of total protein creatinine ratio were significantly lower in the 1400W group after 1 h of reperfusion (1h Pr/Cr: 1400W 9068 ± 6910 mg/L/mmol/L vs Control 21586 ± 5464 mg/L/mmol/L, P = 0.026). Levels of 8-isoprostane were significantly lower in the 1400W group [8-iso/creatinine ratio: Control 239 ± 136 pg/L/mmol/L vs 1400W 139 ± 47 pg/L/mmol/L, P = 0.041]. CONCLUSION: This study demonstrated that 1400W reduced ischaemia reperfusion injury in this porcine kidney model of DCD donor. Kidneys had improved renal function and reduced oxidative stress.     

Barbed polyglyconate vs monocryl suture in vesico-urethral anastomosis during robot-assisted radical prostatectomy

AIM: To compare outcomes using barbed polyglyconate(V-Loc 180) vs monofilament monocryl suture in forming vesico-urethral anastomosis(VUA) during robot assisted radical prostatectomy.METHODS: Review of prospectively collected robot assisted radical prostatectomy data between July 2011 and September 2012. VUA technique: VUA was performed using 2 cm × 15 cm 2/0 V-Loc 180 continuous sutures or 3/0 monofilament monocryl sutures. Anastomotic integrity was tested intra-operatively with a water leak test. All patients had a post-operative cystogram at day 7 to 10.RESULTS: There were 189 patients in the study with 113 in the V-Loc group and 76 in the monocryl group. Demographics were similar for both groups P 0.05). The median operative time for V-Loc group was 130 min and monocryl group was 145 min, which was statistically significant(P 0.001). The median blood loss for both groups was 200 m L with no significant difference(P = 0.260). The pathology results of the 2 groups were similar(P = 0.537). Four patients in the V-Loc group and two patients in the monocryl group had radiological urinary leak. This was not statistically significant(P = 1.00) and all patients improved with conservative management. The continence rates were comparable for both groups.CONCLUSION: V-Loc suture significantly reduced operative time facilitating ease of VUA formation. Overall functional outcome and urinary morbidity were not significantly different from the monofilament group.     

Perioperative outcomes and survival of radical cystectomy as a function of body mass index

AIM: To evaluate the perioperative and long term outcomes of cystectomy in obese patients. METHODS: This is a retrospective review of 580 patients for whom radical cystectomy (RC) was performed for primary urothelial bladder cancer between November 1996-April 2013 at a single institution. Body mass index (BMI) was available for 424 patients who were categorized as underweight (< 18.5), normal (18.5-24.9), overweight (25.0-29.9), and obese (≥ 30). Baseline demographics, perioperative outcomes, and survival were assessed. Overall survival (OS) and disease specific survival (DSS) was estimated by Kaplan-Meier method. Medians were compared using the Mann-Whitney U Test. Categorical variables were compared using the χ² test. A P-value of < 0.05 was considered statistically significant. Statistical analyses were performed using the Software Package for the Social Sciences (SPSS), Version 20 (International Business Machines SPSS, Chicago, IL, United States). RESULTS: The median age of all patients was 69 years (inter-quartile range 60-75) and median follow-up was 23.4 mo (8.7-55.1). Patients were characterized as underweight [9, (2.1%)], normal [113, (26.7%)], overweight [160, (37.8%)], or obese [142, (33.5%)]. Estimated blood loss during RC was higher in the obese group (800 mL) as compared to the normal weight group (500 mL). However, need for transfusion (47.7% vs 52.1%), number of lymph nodes resected (32 vs 30), length of stay (9 d vs 8 d), and 30-d readmission (29.7% vs 25.2%) between obese and normal BMI patients were similar. Obese patients underwent ileal neobladder diversion in 42% of cases, compared to 24% of normal BMI patients (0.003). Normal BMI and obese patients had comparable urinary incontinence (21.4% vs 25.6%, P = 0.343), and need for intermittent catheterization (14.3% vs 5.2%, P = 0.685) at 2 years follow-up. Overall survival was better in obese compared to normal BMI patients on univariate analysis, with median survival of 67 mo vs 37 mo, respectively (P = 0.031). Disease specific survival in these populations followed the same Kaplan Meier curve, with the obese group having a significantly improved OS, P = 0.016. Underweight patients had a significantly worse prognosis, with a median overall survival of 19 mo (P = 0.018). Disease specific survival was significantly worse in the underweight group compared to the obese group, P = 0.007. On multivariate analysis underweight patients remained at increased risk for death (HR = 3.1, P = 0.006), as were older patients (HR = 1.6, P = 0.006), those with multiple nodal metastases (HR = 3.7, P = 0.007), and those who had received neoadjuvant chemotherapy (HR = 2.0, P = 0.015). CONCLUSION: Perioperative outcomes and survival following RC in obese patients is comparable with non-obese patients. Underweight patients have the worst OS and DSS.     

Diffuse reflectance spectrophotometry for skin phototype determination

Background: The Fitzpatrick skin phototype classification scheme has become the standard method for assessing the reaction of the skin to solar stimuli; this method can be easily biased by different factors, such as ethnicity or chronic sun exposure. Methods: Diffuse reflectance spectrophotometry (DRS) is an objective and non‐invasive method used in this work to determine constitutive skin color from the upper volar arm as an objective way of measuring skin pigmentation. A DRS‐determined melanin index that accounts for skin pigmentation was obtained for 35 subjects of Hispanic origin, this melanin index was compared with the physician‐diagnosed and self‐reported skin phototypes. Results: The results show that at least for Hispanic individuals, there is a clear clinical distinction between subjects with skin phototype I and their DRS‐determined melanin index; however, subjects with skin phototypes II–VI have a large melanin index overlap. Conclusion: Clinical assessment of skin phototype can be complemented by using DRS.     

Facial variations in sensory responses

Subjective effects such as stinging, itching and burning commonly occur in the absence of any visible irritation and give rise to discomfort, which may be enough to deter an individual from using even the most effective of skin care products. The purpose of this study was to evaluate the sensitivity of different anatomical regions of the face to determine which region displayed the most intense stinging response to the application of lactic acid. The effect of occlusion on the level of response was also investigated. 45 volunteers were treated with 10% lactic acid on the nasolabial fold, forehead, chin and cheek, occluded and unoccluded for 8 min. Sensory reactions were recorded at 2.5, 5 and 8 min. The response levels on the occluded sites were always significantly lower than on the unoccluded sites, despite the dose per unit area being comparable. Females showed a trend towards being more sensitive to the subjective effects elicited by lactic acid than males, but these results were not conclusive. Interestingly, there was not a complete correlation between individuals who reacted on the nasolabial fold and the other sites, particularly the forehead. A positive stinging response on the nasolabial fold may not necessarily predict subjective responses to a product when used on other areas of the face.     

Diabetes mellitus increases the prevalence of anemia in patients with chronic kidney disease: A nested case-control study

AIM: To compare anemia prevalence between matched chronic kidney disease (CKD) patients with and without diabetes mellitus (DM) and to assess factors associated with anemia development. METHODS: This is a nested case-control study of 184 type-2 diabetic and 184 non-diabetic CKD patients from a prospectively assembled database of a Nephrology outpatient clinic, matched for gender, age and estimated glomerular filtration rate (eGFR). Prevalence of anemia (hemoglobin: Men: < 13 g/dL, women: < 12 g/dL and/or use of recombinant erythropoietin) was examined in comparison, in the total population and by CKD Stage. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with anemia. RESULTS: The total prevalence of anemia was higher in diabetics (47.8% vs 33.2%, P = 0.004). Accordingly, prevalence was higher in diabetics in CKD Stage 3 (53.5% vs 33.1%, P < 0.001) and particularly in Stage 3a (60.4% vs 26.4%, P < 0.001), whereas it was non-significantly higher in Stage 4 (61.3% vs 48.4%; P = 0.307). Serum ferritin was higher in diabetics in total and in CKD stages, while serum iron was similar between groups. In multivariate analyses, DM (OR = 2.206, 95%CI: 1.196-4.069), CKD Stages 3a, 3b, 4 (Stage 4: OR = 12.169, 95%CI: 3.783-39.147) and serum iron (OR = 0.976, 95%CI: 0.968-0.985 per mg/dL increase) were independently associated with anemia. CONCLUSION: Prevalence of anemia progressively increases with advancing stages of CKD and is higher in diabetic than matched non-diabetic CKD patients and diabetes is independently associated with anemia occurrence. Detection and treatment of anemia in diabetic CKD patients should be performed earlier than non-diabetic counterparts.     

非磨削型嫩肤激光对小鼠皮肤失水的影响

目的 研究非磨削型激光嫩肤对皮肤屏障功能的影响.方法 用CooltouchⅡ 1320nm激光、Gentlelase755nm激光、Vbeam595nm激光、GentleYAG1064nm激光照射小鼠皮肤.并用1%透明质酸钠涂抹于GentleYAG 1064nm激光照射后的皮肤,观察1周内皮肤经表皮失水、含水量的变化.结果 激光照射小鼠皮肤1h时就出现了经表皮失水较正常对照组显著性增高(P<0.05),595nm激光照射引起的皮肤经表皮失水值增高在激光照射后的第7天恢复正常(P>0.05).1320nm激光在第2天时恢复正常(P>0.05),1064nm激光在第4天恢复正常(P>0.05),755nm激光在第4天恢复正常(P>0.05).GentleYAG1064nm激光照射部位的皮肤每天用1%透明质酸钠涂抹1次后,经表皮失水值在第4天恢复正常(P>0.05).结论 各种非磨削型嫩肤激光照射小鼠背部皮肤后均引起局部皮肤经表皮失水增加,24h内均未能恢复正常,但是在1周时均可基本恢复正常.波长较短的595nm激光引起的经表皮失水恢复较慢,而波长较长的1320nm激光引起的经表皮失水恢复较快.激光照射后外用1%透明质酸钠无助于皮肤经表皮失水的恢复.     

Proposal of new expanded selection criteria using total tumor size and 18F-fluorodeoxyglucose - positron emission tomography/computed tomography for living donor liver transplantation in patients with hepatocellular carcinoma: The National Cancer Center Korea criteria

AIM: To expand the living donor liver transplantation (LT) pool of eligible patients with hepatocellular carcinoma (HCC) using new morphological and biological criteria. METHODS: Patients with HCC who underwent living donor LT (LDLT) from March 2005 to May 2013 at the National Cancer Center Korea (NCCK) were enrolled. We performed the ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) before LDLT. Overall and disease-free survival analysis was done in patients to evaluate the usefulness of new NCCK criteria using PET/CT and total tumor size (10 cm). RESULTS: We enrolled a total of 280 patients who pathologically confirmed to have HCC and performed the PET/CT before transplantation. Among them, 164 (58.6%) patients fulfilled the NCCK criteria and 132 patients (47.1%) met the Milan criteria. Five-year overall and disease-free survival rates for patients who fulfilled the NCCK criteria showed 85.2% and 84.0%, respectively, and were significantly higher than those beyond the NCCK criteria (60.2% and 44.4%, respectively; P < 0.001). The correlation analysis between preoperative imaging tests and pathologic reports using Cohen’s Kappa demonstrated the better results in the NCCK criteria than those in the Milan criteria (0.850 vs 0.583). The comparison of disease-free analysis among the NCCK, Milan, and University of California, San Francisco (UCSF) criteria using the receiver operating characteristics curves revealed the similar area under the curve value criteria (NCCK vs Milan, P = 0.484; NCCK vs UCSF, P = 0.189 at 5-years). CONCLUSION: The NCCK criteria using hybrid concept of both morphological and biological parameters showed an excellent agreement between preoperative imaging and pathological results, and favorable survival outcomes. These new criteria might select the optimal patients with HCC waiting LDLT and expand the selection pool.     

Reliability of self-assessment in determining skin phototype for Korean brown skin

The widely used skin phototype system first introduced by Fitzpatrick, which is based on the history of an individual tendency to burn and tan, was studied in 733 Korean men by means of a self-assessment questionnaire. Combining two factors, individual burning and tanning tendency, less than half (43.9%) could be classified according to the skin phototype system. Furthermore, the concordant ratio between subjective skin phototypes assessed by the subjects themselves and classification by combining self-reported burning and tanning tendencies was much lower (34.4%). In a subgroup of 156 subjects, the minimal erythema dose (MED) was determined and compared with the reported tendencies to burn and tan. The results showed that subjects with higher MEDs tended to report more tanning. We concluded that in Korean brown skin, there is a disconcordant relationship between reported burning and tanning tendencies and, though reliable for white skin, self-assessed skin phototypes are unreliable in Korean brown skin.     

Relevance of skin phototyping to a Korean population

We have determined skin phototype by a self-reporting questionnaire proposed by Fitzpatrick in 128 Korean medical students. We also measured the minimal erythema dose (MED), minimal melanogenic dose and investigated their relationship to phototype. A questionnaire of skin phototypes revealed that 13.3% of the students are skin phototypes I and II. Based on MEDs, we demonstrated that 14.8% of the students fall into the UV-sensitive group as defined by an MED of less than 40 mJ/cm² which is the upper range of MED of phototypes I and II in a white population. The skin phototypes did not show a positive correlation to MEDs and only 2.3% of students classified as skin phototypes I and II showed an MED below 40mJ/cm². This study indicates that the skin phototyping method proposed by Fitzpatrick does not reliably predict UV-sensitive individuals within the Korean population.     

Counts of Common and Atypical Melanocytic Nevi in Korean Young Men: Assessment of Their Risks and Correlations with Associated Factors

Two hundred and thirty-five Korean young men were examined for the count of melanocytic nevi (MN). The mean count of common MN of at least 2 mm diameter was 16.1. Three subjects had more than 50 common MN and another four had clinically atypical MN. We determined skin phototype by interview with questionnaires in the same persons as proposed by Fitzpatrick. All subjects were classified with respect to skin phototype and the number of previous sunburns. The correlations between common MN and the skin phototype or the number of previous sunburns were statistically analyzed. The skin phototype showed the correlation with the number of common MN, which means if skin phototype of any subject belongs to type I, he could to be predicted to have many more common MN than subjects with darker phototypes, like type VI. The correlation between number of previous sunburns and number of common MN was not statistically significant. This study shows persons at moderate risk of cutaneous melanoma (CM) do exist and skin phototype is associated with the prevalence of common MN in Koreans.     

Acute irritant threshold correlates with barrier function,skin hydration and contact hypersensitivity in atopic dermatitis and rosacea

The aim of the study was to disclose interactions between epidermal barrier, skin irritation and sensitization in healthy and diseased skin. Transepidermal water loss (TEWL) and stratum corneum hydration (SCH) were assessed in adult patients with atopic dermatitis (AD), rosacea and healthy controls. A 4‐h patch test with seven concentrations of sodium lauryl sulphate was performed to determine the irritant threshold (IT). Contact sensitization pattern was revealed by patch testing with European baseline series. Subjects with a lower IT had higher TEWL values and lower SCH. Subjects with positive allergic reactions had significantly lower IT. In AD, epidermal barrier deterioration was detected on both volar forearm and nasolabial fold, while in rosacea, impeded skin physiology parameters were observed on the facial skin only, suggesting that barrier impediment is restricted to the face in rosacea, in contrast with AD where the abnormal skin physiology is generalized.     

Biophysical parameters of skin: map of human face, regional, and age-related differences

The face showed anatomical variation on reaction to chemicals, which could be related to differences in biophysical specificities of the skin. The aim of this study was to establish a map of the face for 6 biophysical parameters.10 young human volunteers (24-34 years) and 10 old volunteers (66-83 years) were studied to prepare a map of the human face based on regional variations and age-related differences by measuring various biophysical parameters. 7 locations on the face, neck, and forearm were investigated. Skin blood flow, transepidermal water loss (TEWL), stratum corneum hydration (capacitance), temperature, pH, and sebum content of the skin surface were measured. In both groups, skin blood flow in the nose showed the highest value. Perioral and nasolabial areas showed the highest TEWL values. The neck showed the highest capacitance value. The highest skin temperature was detected in the neck in the young group and in the nasolabial area in the old group. The chin showed the most alkaline pH in both groups. Nasolabial area showed the highest sebum content in the young group, as did the chin in the old group. These baseline values provide a framework to build on for ascertaining disease and intervention-related effects.     

Differences of skin irritation between Japanese and European women

BACKGROUND: After using cosmetics, Japanese women frequently complain about sensitive, stinging skin. We wondered whether Japanese women's skin is more sensitive than that of Caucasians. OBJECTIVES: To examine possible racial differences of skin irritation and subjective sensations. METHODS: We performed patch testing on the forearm with sodium lauryl sulphate (SLS) at different concentrations (0.25%, 0.5%) and 24-h exposure time. Skin reaction was evaluated by measurement of transepidermal water loss (TEWL), stratum corneum hydration, sebum secretion, laser Doppler flowmetry (LD), content of melanin and erythema. During a stinging test with 10% lactic acid (applied to one side of the cheeks) the subjects were asked to describe the present intensity of any sensation. We used a Chromameter to measure skin colour before and after application of lactic acid. This study was performed in Marburg, Germany, with healthy Japanese and German women living in Marburg. RESULTS: After SLS testing, we found no significant differences of the barrier function in the stratum corneum, but we found significant subjective sensory differences between Japanese and German women. CONCLUSIONS: Japanese women may complain about stronger sensations reflecting a different cultural behaviour rather than measurable differences in skin physiology; however, a faster penetration of SLS in Japanese cannot be excluded.     

Single-lung transplantation in emphysema: Retrospective study analyzing survival and waiting list mortality

AIM: To performed remains a subject of debate and is the principal aim of the study. METHODS: This retrospective analysis included 73 patients with emphysema (2000-2012). The outcomes of patients undergoing single-lung transplantation (SL) (n = 40) or double-lung transplant (DL) (n = 33) were compared in a Cox multivariate analysis to study the impact of the technique, postoperative complications and acute and chronic rejection on survival rates. Patients were selected for inclusion in the waiting list according to the International Society of Heart Lung Transplantation criteria. Pre and postoperative rehabilitation and prophylaxis, surgical technique and immunosuppressive treatment were similar in every patients. Lung transplantation waiting list information on a national level and retrospective data on emphysema patient survival transplanted in Spain during the study period, was obtained from the lung transplantation registry managed by the National Transplant Organization (ONT). RESULTS: Both groups were comparable in terms of gender and clinical characteristics. We found significant differences in the mean age between the groups, the DL patients being younger as expected from the inclusion criteria. Perioperative complications occurred in 27.6% SL vs 54% DL (P = 0.032). Excluding perioperative mortality, median survival was 65.3 mo for SL and 59.4 mo for DL (P = 0.96). Bronchiolitis obliterans and overall 5-year survival were similar in both groups. Bacterial respiratory infection, cytomegalovirus and fungal infection rates were higher but not significant in SL. No differences were found between type of transplant and survival (P = 0.48). To support our results, national data on all patients with emphysema in waiting list were obtained (n = 1001). Mortality on the waiting list was 2.4% for SL vs 6.2% for DL. There was no difference in 5 year survival between 235 SL and 430 DL patients transplanted (P = 0.875). CONCLUSION: Our results suggest that SL transplantation in emphysema produce similar survival than DL with less postoperative complication and significant lower mortality in waiting list.