SINGLE-LUNG TRANSPLANTATION IN PATIENTS WITH SYSTEMIC-DISEASE

Objective: To report functional results and survival in patients under going single lung transplantation (SLT) for pulmonary involvement asso ciated with systemic disease or prior malignancy, criteria traditional ly considered contraindications to SLT. Design: Case series. Setting: The University of Texas Health Science Center at San Antonio. Patients : Nine patients who have undergone SLT for end-stage lung disease: fou r patients with sarcoidosis; two patients with limited scleroderma; an d three patients with prior malignancies (two with prior lymphoma and bleomycin-induced pulmonary fibrosis and one who received two bone mar row transplants for acute lymphocytic leukemia and subsequently develo ped chemotherapy-induced pulmonary fibrosis). Measurements: Pulmonary function testing, exercise oximetry, quantitative ventilation-perfusio n lung scanning. Actuarial survival. Results: All patients had marked improvement in pulmonary function, exercise oximetry, and quantitative ventilation perfusion to the SLT. One patient with scleroderma died 9 0 days postoperatively from Pseudomonas pneumonia with a sepsis syndro me. One patient with sarcoidosis died 150 days postoperatively from di sseminated aspergillosis. At autopsy, there was no evidence of recurre nt fibrosis or sarcoidosis in the transplanted lungs in either of thes e two patients. The seven surviving patients have returned to work or school and are conducting all activities of daily living without pulmo nary disability. The 1- and 2-year actuarial survival rates in these n ine patients is 68.6 percent as compared with the 1- and e-year actuar ial survival rates of 66.3 percent and 55.8 percent in the remainder o f our SLT group as a whole (n=49). Despite pharmacologic immunosuppres sion, there is no evidence of recurrent malignancy in the 3 patients w ith prior malignancies. Conclusions: We conclude that carefully select ed patients with end-stage lung involvement related to systemic diseas e or chemotherapy-induced fibrosis may benefit from SLT.