VOLUME REDUCTION SURGERY IN THE NATIVE LUNG AFTER SINGLE-LUNG TRANSPLANTATION FOR EMPHYSEMA

The natural history of emphysema suggests that progression of disease in the native lung may contribute to late deterioration in respiratory function after single lung transplantation. In this report, we descri be our experience with unilateral volume reduction surgery in three si ngle lung transplant recipients with emphysema. Each patient had had a late decline in lung function with a recurrence of symptoms. Chest ra diographs demonstrated hyperinflation of the native lungs with encroac hment on the grafts. Serial pulmonary function testing documented prog ressive reduction in expiratory flows with increases in residual volum es. Exercise testing confirmed severe intolerance to maximal exercise. Unilateral volume reduction surgery was undertaken at 36, 39, and 55 months after transplantation without incident. Radiographs obtained af ter the procedures demonstrated restoration of normal diaphragmatic co ntour, decreased aeration of the native lungs, and improved inflation of the allografts. Exercise testing at 3 months documented a mean impr ovement in maximal oxygen consumption of 35%. Expiratory flows improve d by a mean of 60%. Quantitative ventilation and perfusion scans, howe ver, were essentially unchanged. This experience suggests that unilate ral volume reduction surgery may be considered as an alternative strat egy in single lung transplant recipients with emphysema who exhibit cl inically significant functional deterioration. Differentiation of the adverse effects of hyperinflation of the native lung from other potent ial causes of late deterioration might not be necessary but may be pre dictive of the degree of functional improvement after volume reduction . The relief of thoracic overdistention seems to play a primary role i n the improvement pulmonary function.