Lung transplantation versus lung volume reduction as surgical therapy for emphysema

There are currently two surgical therapies aimed at crippling, end-stage em physema: lung transplantation and lung volume reduction surgery (LVRS). Unf ortunately, most emphysema patients are poor candidates for any surgical in tervention. The authors favor a meticulous selection process in which indic ations and contraindications are considered and the best solution is devise d for each patient. Patients with ideal circumstances for LVRS-hyperinflati on, heterogeneous distribution of disease, FEV, of more than 20%, and norma l PCO2-are offered LVRS. Patients with diffuse disease, low FEV1, hypercapn ia, and associated pulmonary hypertension are directed toward transplantati on. LVRS has not been a satisfactory option for patients with a(1)-antitryp sin deficiency, and we prefer a transplant in most of these patients. With these considerations, we find that few patients are serious candidates for both procedures. Combinations of lung volume reduction and lung transplanta tion, simultaneously or sequentially, are possible but rarely necessary.