Single Lung Transplantation in Experimental and Human Emphysema

Veith, Frank J.; Koerner, Spencer K.; Siegelman, Stanley S.; Torres, Michael; Bardfeld, Philip A.; Attai, Lari A.; Boley, Scott J.; Takaro, Timothy; Gliedman, Marvin L.

doi:10.1097/00000658-197310000-00009

Cited by 70 publications

(21 citation statements)

References 19 publications

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“…Subsequent studies showed that ventilation/perfusion alterations are not constant and are usually associated with characteristic alterations of the graft [10,11] such as rejection, infection or reimplantation injury. Furthermore, hyperinflation of the native lung causes graft compression, but only when the function of the newlyimplanted lung is impaired.…”

Section: Discussionmentioning

confidence: 99%

Lung transplantation for emphysema. Lung hyperinflation: incidence and outcome

et al. 2005

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Lung transplantation, single or bilateral sequential, is the final option for patients with emphysema. This study analyzed the outcome of lung transplants for emphysema (single or double), and evaluates the incidence, predictive factors and prognosis of lung hyperinflation (LHI) in unilateral transplants. We prospectively studied patients undergoing lung transplantation for emphysema. On admission to the Intensive Care Unit (ICU) and at 12, 24, 48 and 72 h we tested the patients' respiratory function, oxygen arterial pressure (PaO2) and mean pulmonary arterial pressure (MPAP) before transplantation. LHI incidence, duration of mechanical ventilation and hypoxemia, ICU stay and mortality was also analyzed. We studied 34 consecutive patients undergoing lung transplantation for emphysema, 14 single and 20 bilateral. Single-lung transplantation had a higher mortality (50%) than double-lung transplantation (11%), with an odds ratio of 9.0 (1.3-48.7). Of the 14 patients who received a single graft, 9 patients (64%) developed LHI. No predictive factors for LHI could be established. Duration of mechanical ventilation (22 vs 3 days) and ICU stay (36 vs 6 days) was much longer in patients with LHI; however, only ICU stay reached statistical significance (P = 0.011). Mortality in patients with LHI was higher, 67% vs 20% (NS). We conclude that single-lung transplant in emphysema patients has a worse prognosis than bilateral transplant, with a 9-fold higher mortality rate. LHI is a common event in single-lung transplant for emphysema and is associated in our patients with a longer stay at the ICU.

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Section: Discussionmentioning

confidence: 99%

Lung transplantation for emphysema. Lung hyperinflation: incidence and outcome

et al. 2005

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“…The use of plication [1,16], local excision [14], segmental resection [17], lobectomy [13] and even lung transplantation [18] have been reported, with variable results [1,[13][14][15][16][17][18]. The resection of giant bullae might be viewed as a special case of lung volume reduction in severe emphysema; in both instances the principle is to reduce lung volume by resecting the worst functioning lung tissue.…”

Section: Discussionmentioning

confidence: 99%

Treatment by VATS of giant bullous emphysema: results

Menconi

Melfi

Mussi

et al. 1998

European Journal of Cardio-Thoracic Surgery

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Objective: In selected patients with giant bullous emphysema GBE and in those with specific complications, surgery may be the treatment of choice. Methods: In the period January 1993 -February 1996 we performed 34 VATS treatments in 29 patients affected by GBE. There were 22 (76%) males and 7 (24%) females, with a mean age of 54 years (range 24 -74). In 23 cases, a pneumothorax (PNX) was present at admission, while 6 patients were treated by choice. Altogether, we performed 23 resections of sessile bullae (type 2 of Reid) by using a linear endoscopic stapling device (Endo-path 35 and 45 mm) and 11 ligatures of pedicled bullae (type 1 of Reid) by loop (Endo-loop 'PDS'). The mean number of charges for every treatment was 8 (range 4-21). The largest bullae were perforated and deprived of incarcerated air. They were then twisted on the axis perpendicular to the base in order to improve the manoeuvrability of the lesion and favour the correct placement of the Endo-path or Endo-loop. GBE was bilateral in 7 cases: one of these was treated bilaterally in the same surgical stage, other 4 were treated by staged operations. Results: We experienced two conversions to open thoracotomy (one sessile giant bulla inside the fissura; 1 case of strong tuberculous pleural adhesions). Two patients, underwent a second operation by open thoracotomy because of a prolonged air leak. We have two peri-operative deaths, both to respiratory failure. Altogether, in 23 out of 29 (79%) cases VATS was effective and the mean hospital stay was 6 days (range 3-16). At a mean follow up of 16 months (range 1 -36) no recurrence of PNX was observed. Conclusions: VATS may be considered as a suitable surgical technique to approach GBE and, in most cases, it is effective.

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“…4 Similarly, we believe that singlelung transplantation for patients with cystic fibrosis or other forms of chronic pulmonary sepsis is not advisable, as persistent infection in the remaining, native lung would pose a significant hazard, especially in the immunosuppressed recipient. We have not considered single-lung transplantation for patients with emphysema, out of concern that the remaining, native lung would hyperexpand, resulting in crowding of the transplanted lung.…”

Section: Follow-up Evaluationmentioning

confidence: 99%