PULMONARY HEMODYNAMICS AFTER SINGLE-LUNG TRANSPLANTATION FOR END-STAGE PULMONARY PARENCHYMAL DISEASE

In a prospective study, we investigated the effect of single-lung tran splantation (SLT) on pulmonary haemodynamics and the relationship betw een pulmonary hypertension (PH) and the fraction of perfusion to the t ransplant in patients with end-stage pulmonary parenchymal disease. Tw enty four SLT recipients were included in the study, 19 with chronic o bstructive pulmonary disease (COPD), two with sarcoidosis and three wi th fibrosing alveolitis. Spirometry, determination of arterial blood g as values, perfusion scintigraphy and right heart catheterization were performed before and 1, 6, 12 and 24 months after transplantation. Pa tients with a mean pulmonary artery pressure ((P) over bar)pa greater than or equal to 20 mmHg before transplantation were defined as having PH (PH group, 15 patients) and the remainder (9 patients) constituted the non-PH group. In the PH group, (P) over bar pa and pulmonary vasc ular resistance (PVR) were significantly decreased after transplantati on: 28+/-2 to 18+/-1 mmHg and 288 to 161+/-11 dyne . s(-1). cm(-5), re spectively (mean+/-SEM). In the non-PH group, the haemodynamic paramet ers were unchanged after transplantation. Over the 2 year follow-up pe riod, no significant change was found in (P) over bar pa and PVR, nor any difference between the PH and non-PH group. There was no significa nt difference between the two groups in terms of pulmonary perfusion t o the graft. In conclusion, patients with pulmonary hypertension obtai n pulmonary haemodynamics within the normal range after single-lung tr ansplantation. Presence or absence of pulmonary hypertension before tr ansplantation does not influence perfusion to the graft. These finding s persist up to 2 yrs, despite the coexistence of an ''end-stage'' nat ive lung and a lung transplant.