SINGLE-LUNG TRANSPLANTATION FOR END-STAGE EMPHYSEMA

Background - The first successful single lung transplantation was carr ied out in 1983 for pulmonary fibrosis. Because of the inherent advant ages of single lung transplantation, a transplantation programme has b een started for patients with end stage lung disease due to emphysema. Methods - Between October 1990 and August 1993 25 patients with sever e emphysema (15 men, mean age 51 years) received a single lung transpl ant at our institution. All patients were severely disabled with a mea n (SD) 12 minute walking distance of 281 (165) metres. There were five deaths in the series, four in the first 20 days and one on day 503, T wo patients suffered graft compression by air trapping in the native l ung. Bronchial narrowing requiring insertion of endobronchial stenting occurred in four patients. Results - Mean (SD) FEV(1) improved from a preoperative value of 17.8(13)% predicted to a six month value of 53. 6(13)%, and FEV(1)/FVC from 23.8(12)% to 68.6(15)%. After the transpla nt 12 patients are in New York Heart Association (NYHA) class I and th e rest of the survivors are in NYHA II. Actuarial survival was 82% at one year and 74% at three years. Conclusions - Single lung transplanta tion is an effective treatment for end stage lung disease due to emphy sema and carries an acceptable mortality and morbidity.