UNILATERAL VOLUME REDUCTION AFTER SINGLE-LUNG TRANSPLANTATION FOR EMPHYSEMA

Background. Single-lung transplantation has become accepted therapy fo r patients with end-stage emphysema. Hyperinflation of the native lung can occur after single-lung transplantation with mediastinal shifting and compression of the transplanted lung. A volume reduction operatio n (pneumonectomy) may relieve symptoms of dyspnea and improve exercise tolerance. Methods. Three of 66 patients who underwent single-lung tr ansplantation for emphysema had development of native lung hyperexpans ion and mediastinal shifting causing compression of the transplanted c ontralateral lung at 12, 17, and 42 months after transplantation. Ther e were 2 men and 1 woman. Unilateral volume reduction was performed wi thout complication in all 3 patients. Results. All patients were noted to have marked improvement in chest radiographs after volume reductio n, substantial relief of dyspnea, and improvement in exercise toleranc e. An improvement in pulmonary function test results was noted in 1 pa tient, but tests were not done for the other 2 patients. Conclusions. Patients with chronic obstructive pulmonary disease who undergo single -lung transplantation may have symptomatic hyperexpansion of the nativ e lung requiring volume reduction months to years after transplantatio n. Unilateral volume reduction can be safely performed in the posttran splantation period.