SINGLE-LUNG TRANSPLANTATION FOR CHRONIC OBSTRUCTIVE PULMONARY-DISEASE- PULMONARY-FUNCTION AND IMPACT OF BRONCHIOLITIS OBLITERANS SYNDROME

Chronic obstructive pulmonary disease (COPD) is now the most common in dication for single lung transplantation. In long-term follow-up, obli terative bronchiolitis is a major problem, The aim of the present stud y was to perform a long-term follow-up of the pulmonary function and t o examine the effect of development of bronchiolitis obliterans syndro me (BOS). Nineteen patients with end-stage COPD underwent single lung transplantation and were followed regularly with pulmonary function te sts, and ventilation and perfusion scintigraphy (mean observation time 29 months). They were divided into two categories, with and without B OS, using the definition recommended by the International Society for Heart and Lung Transplantation working group. A mixed model analysis o f variance with BOS as co-variate was used to evaluate its effect on p ulmonary function. Spirometry, lung transfer factor for carbon monoxid e (TLCO), arterial blood gases and 6-min walk test improved significan tly (P<0 . 001) from before transplantation to 3 months after transpla ntation. Nine patients developed BOS. Implied by the definition of the syndrome, forced expiratory volume in 1 s (FEV(1)) was significantly (P<0 . 001) lower for patients with BOS while there was no significant effect of BOS category on TLCO corrected for alveolar volume (VA) or perfusion to transplant. Patients without BOS maintained their pulmona ry function, and ventilation and perfusion to transplant for more than 3 yr after transplantation. The present results suggest that decreasi ng FEV(1) accompanied by an unchanged TLCO/VA and pulmonary perfusion support the diagnosis of BOS after single lung transplantation for COP D.