SURGICAL-TREATMENT FOR SEVERE LUNG EMPHYS EMA - TRANSPLANTATION OR VOLUME REDUCTION

In recent years, lung transplantation (LT) and volume reduction surger y (LVRS) have been proposed for selected patients with end-stage pulmo nary emphysema. Retrospectively, we analyzed the perioperative time co urse of 30 patients with emphysema who underwent either LVRS (n = 17) or LT (n = 13). In the LVRS group, patients were significantly older, presented less severe functional disability and all but one could be e xtubated at the end of surgery. In contrast, patients undergoing LT re quired postoperative mechanical ventilation (19+/-21 hrs) and had a pr olonged hospital stay (37 [25-60] days vs 19 [1l-42] days in LVRS pati ents) due to reperfusion lung edema, infection, hemorrhage and acute r ejec- tion. Six months postoperatively, forced expiratory volume in 1 second was improved and was significantly larger after LT compared wit h LVRS (+200% vs +63%). Our preliminary results suggest that, although LT produces greater functional improvement, LVRS is associated with l ower surgical risk and is an alternative therapy in selected patients with severe emphysema.