ROLE OF LUNG REDUCTION IN LUNG-TRANSPLANT CANDIDATES WITH PULMONARY-EMPHYSEMA

Background. The average waiting time for candidates for lung transplan tation (LTx) with end-stage emphysema is 21 months with a 15% mortalit y. We hypothesized that lung reduction might offer an alternative to L Tx. Methods. Of 95 patients with end-stage emphysema evaluated by our LTx program, 45 were accepted for both lung reduction and LTx and 35 u nderwent lung reduction. Results. All 35 patients survived lung reduct ion. Thirty patients had a follow-up of 3 months. There was a signific ant improvement (p < 0.05) of forced expiratory volume in 1 second (0. 64 to 0.97 L), forced vital capacity (2.12 to 2.76 L), residual volume (5.62 to 4.26 L), maximum voluntary ventilation (28.1 to 38.5 L/min), 6-minute walk (904 to 1,012 feet), Borg dyspnea index (3.7 to 2.4), a nd arterial carbon dioxide tension (44.9 to 41.6 mm Hg). Twenty patien ts (66%) were removed from the LTx list due to their significant impro vement (group A). Compared with the remaining 10 patients with 3 month s of follow-up (group B), percent increase in forced expiratory volume in 1 second (70% in group A versus 27% in group B) and in forced vita l capacity (41% group A versus 18% group B) and percent decrease in re sidual volume (26% group A versus 1.5% group B) were significantly bet ter in group A (p < 0.01). Seven patients in group B were bridged to L Tx; 6 of these patients (86%) had hypercarbia before lung reduction co mpared with 8 (40%) in group A (p < 0.05). All are alive after LTx: th e forced expiratory volume in 1 second is 53% and the forced vital cap acity is 64% of predicted. Conclusions. Lung reduction is safe and eff ective in selected LTx candidates with end-stage emphysema and has the potential to provide an alternative to LTx. Longterm follow-up is war ranted to confirm these results.