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John D. Mitchell
David A. Fullerton
Joseph C. Cleveland
Marvin Pomerantz
Frederick L. Grover
Michael J. Weyant
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Right arrow Lung - transplantation

J Thorac Cardiovasc Surg 2008;135:931-937
© 2008 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Native lung volume reduction surgery relieves functional graft compression after single-lung transplantation for chronic obstructive pulmonary disease

T. Brett Reece, MDa, John D. Mitchell, MDa, Martin R. Zamora, MDb, David A. Fullerton, MDa, Joseph C. Cleveland, MDa, Marvin Pomerantz, MDa, Dennis M. Lyu, MDb, Frederick L. Grover, MDa, Michael J. Weyant, MDa,*

a Division of Cardiothoracic Surgery, University of Colorado Health Sciences Center, Denver, Colo
b Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver, Colo

Received for publication June 23, 2007; revisions received September 20, 2007; accepted for publication October 22, 2007.

* Address for reprints: Michael J. Weyant, MD, 4200 E 9th Ave, Suite C310, Denver, CO 80262. (Email: michael.weyant{at}uchsc.edu).

Objective: Single-lung transplantation is an accepted treatment for end-stage lung disease caused by chronic obstructive pulmonary disease. A complication unique to single-lung transplantation for chronic obstructive pulmonary disease is graft dysfunction due to compression caused by native lung hyperinflation. We hypothesized that patients with functional compromise from native lung hyperinflation would benefit from native lung volume reduction surgery.

Methods: The charts of all patients undergoing single-lung transplantation for chronic obstructive pulmonary disease were reviewed for lung volume reduction surgery of their native lung. Data regarding length of stay, surgical morbidity and mortality, overall survival, type of lung volume reduction surgery, and pulmonary function were recorded to evaluate the effect of lung volume reduction surgery.

Results: Between February 1992 and May 2007, 206 single-lung transplantations were performed for chronic obstructive pulmonary disease. Ten (5%) patients had clinically significant graft compression from native lung hyperinflation. After excluding other causes for functional decline, these patients underwent a modified lung volume reduction surgery between 12 and 142 months after single-lung transplantation (mean, 50 months). Lung volume reduction surgery consisted of anatomic resection. Two (20%) of 10 patients died during their hospitalization. Of the remaining 8 patients, 7 (87.5%) have demonstrated functional improvement on the basis of forced expiratory volume in 1 second improving from 12% to 200% (mean improvement, 57%). Within 6 months of lung volume reduction surgery, mean 6-minute walk values improved significantly (866 to 1055 feet), whereas desaturation with exertion decreased significantly.

Conclusions: Lung volume reduction surgery by means of formal lobectomy in patients with native lung hyperinflation undergoing single-lung transplantation and significant graft compression appears feasible. Additionally, improvements in forced expiratory volume in 1 second can be accomplished in nearly all properly selected patients. Lung volume reduction surgery should be considered in patients with decreasing graft function caused by graft compression from native lung hyperinflation.

Abbreviations and Acronyms BOS = bronchiolitis obliterans syndrome; COPD = chronic obstructive pulmonary disease; CT = computed tomography; FEV1 = forced expiratory volume in 1 second; LVRS = lung volume reduction surgery; NLH = native lung hyperinflation; SLT = single-lung transplantation




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J. G. Augoustides, S. M. Watcha, A. Pochettino, and D. R. Jobes
Early tracheal extubation in adults undergoing single-lung transplantation for chronic obstructive pulmonary disease: pilot evaluation of perioperative outcome
Interactive CardioVascular and Thoracic Surgery, October 1, 2008; 7(5): 755 - 758.
[Abstract] [Full Text] [PDF]


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