Endoscopic treatment of native lung hyperinflation using endobronchial valves in single‐lung transplant patients: a multinational experience

Perch, Michael; Riise, Gerdt C.; Hogarth, Kyle; Musani, Ali I.; Springmeyer, Steven C.; González, Xavier; Iversen, Martin

doi:10.1111/crj.12116

Cited by 15 publications

(11 citation statements)

References 15 publications

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“…EVLR after LTx has been reported by Perch et al [27], who inserted endobronchial valves in hyperinflated native lungs in 14 patients subsequent to single-lung transplantation for emphysema. Two patients suffered from pneumothoraces, 1 developed pneumonia at the time of valve placement, and another developed an infection in the subsequent days.…”

Section: Discussionmentioning

confidence: 99%

Lung Transplantation after Endoscopic Lung Volume Reduction

Fuehner¹,

Clajus²,

Fuge³

et al. 2015

Respiration

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Background: Endoscopic lung volume reduction (ELVR) has become an established treatment option in selected patients with end-stage lung emphysema. ELVR, however, does not always prevent disease progression, and patients may inevitably be considered for lung transplantation. Objectives: Currently, limited data exist regarding the impact of preceding ELVR on lung transplantation outcomes. Methods: A retrospective, single-center analysis of lung transplantation (LTx) waiting list candidates, who had previously undergone ELVR for emphysema between 2010 and 2014, was performed. Outcomes were compared to matched (1:2) controls who underwent LTx for emphysema without previous ELVR. The 12-month survival after LTx represented the primary end point. Results: In total 23/693 (3%) patients listed for LTx between January 2010 and May 2014 had undergone ELVR, of whom 20/23 (87%) proceeded to LTx (ELVR group). Forty matched non-ELVR emphysema patients acted as controls. Bronchiectasis on CT prior to LTx was more evident in ELVR patients [11/20 (55%) vs. 12/40 (30%); p = 0.04] as well as airway colonization after LTx [10/20 (50%) vs. 6/40 (15%); p = 0.004]. Among ELVR patients, the most prevalent colonizing organism was Stenotrophomonas maltophilia (4/10 patients, 40%). No significant differences were observed in LTx waiting list time, duration of LTx procedure, ventilatory support, ICU stay after LTx or time to hospital discharge. One ELVR patient (5%) died 189 days after LTx from pneumonia, compared to 1 non-ELVR patient (3%) who died after 269 days (p = 0.61). Conclusions: Previous ELVR treatment was not associated with differing outcomes following LTx. Increased bacterial colonization rates were evident and warrant further investigation.

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Section: Discussionmentioning

confidence: 99%

Lung Transplantation after Endoscopic Lung Volume Reduction

Fuehner¹,

Clajus²,

Fuge³

et al. 2015

Respiration

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“…Other novel techniques such as lung volume reduction coils, bronchial thermal vapor, and installation of bio-degradable gel or polymers have also demonstrated efficacy in severe diffuse emphysema, yet, they remain experimental in the United States[ 17 - 19 ]. Perch et al[ 20 ] conducted a case series of 14 patients with native lung hyperinflation in SLT patients and demonstrated significant improvement in lung function and symptoms with endobronchial valves[ 20 ]. The study demonstrated the feasibility of endoscopic treatment for native lung hyperinflation in SLT patients, but prospective trials are required to assess its real efficacy.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous pneumothorax in a single lung transplant recipient-a blessing in disguise: A case report

Deshwal

Ghosh

Hogan

et al. 2020

WJCC

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BACKGROUND End-stage chronic obstructive pulmonary disease (COPD) is one of the common lung diseases referred for lung transplantation. According to the international society of heart and lung transplantation, 30% of all lung transplantations are carried out for COPD alone. When compared to bilateral lung transplant, single-lung transplant (SLT) has similar short-term and medium-term results for COPD. For patients with severe upper lobe predominant emphysema, lung volume reduction surgery is an excellent alternative which results in improvement in functional status and long-term mortality. In 2018, endobronchial valves were approved by the Food and Drug Administration for severe upper lobe predominant emphysema as they demonstrated improvement in lung function, exercise capacity, and quality of life. However, the role of endobronchial valves in native lung emphysema in SLT patients has not been studied. CASE SUMMARY We describe an unusual case of severe emphysema who underwent a successful SLT 15 years ago and had gradual worsening of lung function suggestive of chronic lung allograft dysfunction. However, her lung function improved significantly after a spontaneous pneumothorax of the native lung resulting in auto-deflation of large bullae. CONCLUSION This case highlights the clinical significance of native lung hyperinflation in single lung transplant recipient and how spontaneous decompression due to pneumothorax led to clinical improvement in our patient.

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“…Also, LVRS of the native lung at the same time of LuTX was reported in four patients were hyperinflation was to be expected (65)(66)(67). More recently ELVR was used to counteract NLH (51,65,(68)(69)(70)(71). All reports share a high rate of success in terms of improving lung function and reducing subjective breathlessness of patients affected by NLH.…”

Section: Lvr After or During Lutxmentioning

confidence: 99%

Lung volume reduction followed by lung transplantation—considerations on selection criteria and outcome

Slama¹,

Taube²,

Kamler³

et al. 2018

J. Thorac. Dis

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Lung transplantation (LuTX) and lung volume reduction (LVR), either surgical (LVRS: lung volume reduction surgery) or endoscopic (ELVR: endoscopic lung volume reduction), are established therapies in the treatment of end-stage chronic obstructive pulmonary disease (COPD) patients. Careful patient selection is crucial for each intervention. If these techniques are sequentially applied there is a paucity of available data and individual center experiences vary depending on details in selection criteria and operative technique. This review aims to summarize the published data with a focus on LuTX after LVRS. This review covers patient selection for LuTX and LVR, technical considerations, limitations and outcomes. Published literature was identified by systematic search on Medline and appropriate papers were reviewed. Seven case reports/series, 7 comparative observational studies and one multicenter database analysis incorporating a total of 284 patients with LuTX and LVR were evaluated. Prior LVR can significantly affect intraoperative and postoperative risks after subsequent LuTX. Careful patient selection and timing and the choice of appropriate techniques such as minimal invasive LVRS and using ECMO as extracorporeal support during LuTX if required can minimize those risks, ultimately leading to very good postoperative outcomes in terms of lung function and survival. LVRS has the potential to delay listing and to bridge patients to LuTX by improving their physical condition while on the waiting list. After single lung transplantation (SLuTX) contralateral LVRS can counteract the deleterious effects of native lung hyperinflation (NLH). LVR and LuTX are adjunct therapies in the treatment of end-stage COPD. The combination of both can safely be considered in selected patients.

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Endoscopic treatment of native lung hyperinflation using endobronchial valves in single‐lung transplant patients: a multinational experience

Abstract: Treating NLH with IBV endobronchial valves leads to clinical improvement in the majority of patients, and the treatment has an acceptable safety.

Cited by 15 publications

References 15 publications

Lung Transplantation after Endoscopic Lung Volume Reduction

Lung Transplantation after Endoscopic Lung Volume Reduction

Spontaneous pneumothorax in a single lung transplant recipient-a blessing in disguise: A case report

Lung volume reduction followed by lung transplantation—considerations on selection criteria and outcome

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