FUNCTIONAL RESULTS OF SINGLE-LUNG TRANSPLANTATION FOR CHRONIC OBSTRUCTIVE LUNG-DISEASE

The feasibility and immediate tolerance of single-lung transplantation were recently demonstrated in patients with severe obstructive lung d isease. Since initial reports, hundreds of procedures have been perfor med worldwide in such patients, but views regarding the results are st ill controversial. Since few data concerning medium-term functional re sults are available, we report here our series of 20 patients with chr onic obstructive pulmonary disease who received a single-lung transpla nt. A group of 16 patients who survived for 6 mo or more form the basi s of this report. Current 1- and 2-yr actuarial survival are 75 and 70 %, respectively, with 4 perioperative deaths and 2 deaths at 9 and 15 mo af ter transplantation. Before transplantation the patients were se verely obstructive, with a FEV(1) of 17 +/- 6% of predicted, a Pao(2) of 51 +/- 10 mm Hg, a Pace, of 49 +/- 11 mm Hg, and a 6 min walk test of 99 +/- 84 m. A significant functional improvement was observed post operatively, the patients' FEV(1) at 3 mo reached 53 +/- 13%, Pao(2) 8 1 +/- 3 mm Hg, and Pace, 39 +/- 3 mm Hg. The distance covered during 6 min was 587 +/- 147 m at 6 mo. Throughout postoperative follow-up, lu ng function remained stable in some patients but decreased in others a fter several mo, this decline related to the occurrence of bronchiolit is obliterans, except in two patients who had airway complications. Im pairment in lung function led to retransplantation in four patients, w ith good clinical results in three patients, one patient dying postope ratively. We conclude that single-lung transplantation is an effective treatment in patients with severe chronic obstructive disease that gi ves good medium-term functional results.