Outcome of bilateral lung volume reduction in patients with emphysema potentially eligible for lung transplantation

Objective: Between January 1993 and May 1998, we performed 200 consecutive bilateral lung volume reduction operations. After initial assessment, 99 of these patients were eligible for lung volume reduction and potentially eli gible for immediate or eventual lung transplantation on the:basis of age an d absence of contraindications. All chose to proceed with lung volume reduc tion surgery The outcomes of these 99 patients are reviewed to assess the c onsequences of proceeding with lung volume reduction surgery on patients po tentially eligible for lung transplantation. Methods: A retrospective study was performed with the use of a prospectivel y assembled computer database. Results: The 61 men and 38 women were 55 +/- 7 years old at evacuation for lung volume reduction. Mean values for first second expired volume, total l ung capacity, and residual volume were 24% +/- 8%, 141% +/- 19%, and 294% /- 54% predicted. There-were 4 operative deaths and 17 late deaths. Two-yea r and 5-year survival after evaluation for lung volume reduction are 92% an d 75%. The 32 patients who have been listed:for transplantation after lung volume reduction include 15 who have undergone transplantation, 14 who rema in on the list, and 3 who have been removed from the List. All 15 transplan t recipients survived transplantation and 3 have subsequently died of rejec tion or late infection. The 12 living recipients have a: median post-transp lantation follow-up of 1.7 years. The age at transplantation was 58 +/- 5 y ears with transplantation occurring 3.8 +/- 1.1 years after lung volume red uction. Sixteen of 99 patients underwent lower lobe volume reduction with a n increased rate of listing (63%, P = .008) and transplantation (38%, P = . 003) compared with patients undergoing upper lobe volume reduction. Patient s listed for transplantation were younger, more impaired, and experienced l ess benefit from lung volume reduction than patients not yet listed for tra nsplantation. Conclusions: The preliminary use of lung volume reduction in patients poten tially suitable for transplantation does not appear to jeopardize the chanc es for subsequent successful transplantation.