Volume reduction of the native lung after single-lung transplantation for emphysema

Kapelanski, David P.; Anderson, Mark; Kriett, Jolene M.; Colt, Henri G.; Smith, Cecilia M.; Mateos, Manuel Rivera; Jamieson, Stuart W.

doi:10.1016/s0022-5223(96)70354-9

Cited by 31 publications

(12 citation statements)

References 3 publications

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“…In this sense, emphysema is a disease in which functional restriction of oversized lungs in a normal or abnormally large chest wall contributes to ventilatory dysfunction. After single lung transplantation for emphysema, functional restriction occurs when hyperinflation of the native lung overfills a chest wall that may be supernormal in its ability to expand (6)(7)(8)(9)(10)(11). The model predicts that surgical reduction of the lungs in patients with emphysema, or of the native (emphysematous) lung in patients after transplantation, can reduce functional restriction and underexpansion of both lungs, improving ventilatory function.…”

Section: Discussionmentioning

confidence: 99%

Model of Functional Restriction in Chronic Obstructive Pulmonary Disease, Transplantation, and Lung Reduction Surgery

Loring

Leith²,

Connolly³

et al. 1999

Am J Respir Crit Care Med

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Mechanical interactions between lung and chest wall are important determinants of respiratory function. When chest wall expansion during maximal inhalation generates insufficiently negative pleural pressures, the lungs remain functionally underinflated; this may be termed functional restriction. To explore mechanisms and effects of functional restriction in patients with emphysema, and to predict effects of single lung transplantation and lung volume reduction surgery (LVRS), we used a computational model based on standard physiology and measurements from individual patients. The model's lungs, separated by a compliant mediastinum, exhibit flow limitation according to the equal pressure point approach of Mead and coworkers. Pulmonary elastic recoil pressure is characterized by an exponential equation modified to reflect airway closure. Simulated respiratory maneuvers can be specified by variations in flow or pressure at the airway opening or in respiratory muscle activation. Model simulations successfully mimic recordings from individual patients. Input parameter values may then be altered to predict effects of surgical interventions in these same patients. The model simulations show the following. Single lung transplantation in emphysema can cause functional restriction of the normal transplanted lungs, and larger transplanted lungs may perform less well than smaller ones. LVRS improves lung and chest wall function in emphysema, but not in normal states. Surgical reduction of the native emphysematous lung after single lung transplantation can reduce functional restriction of the transplant and thereby improve its function.

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Section: Discussionmentioning

confidence: 99%

Model of Functional Restriction in Chronic Obstructive Pulmonary Disease, Transplantation, and Lung Reduction Surgery

Loring

Leith²,

Connolly³

et al. 1999

Am J Respir Crit Care Med

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show abstract

“…A number of studies have reported functional improvement in patients after surgical treatment. (11) Although this procedure can be performed simultaneously with transplantation, it can also be performed later, when hyperinflation is identified. This functional improvement is evidenced by improved exercise capacity, better pulmonary function test results and decreased dyspnea.…”

Section: Casementioning

confidence: 99%

Hiperinsuflação pulmonar após transplante unilateral por enfisema

et al. 2010

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Apesar das medidas de prevenção, a hiperinsuflação pulmonar é uma complicação relativamente comum após transplantes unilaterais por enfisema. Quando progressiva, pode comprimir o pulmão transplantado, gerando desvio mediastinal e insuficiência respiratória. Além de estratégias terapêuticas como a ventilação independente, o tratamento consiste na redução volumétrica do pulmão nativo, seja por meio de cirurgia redutora, seja por lobectomia. São relatados dois casos de hiperinsuflação do pulmão nativo após transplante pulmonar, tratados com redução volumétrica do pulmão por meio de lobectomia ou cirurgia redutora.

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“…Progressive hyperinflation of the native lung after single‐lung transplantation for emphysema may influence PFTs and mimic BOS (18–20). Although it may be very difficult to distinguish native lung hyperinflation from BOS, this diagnosis should be considered because several case series have shown lung‐volume reduction surgery to be an effective treatment modality (21–26). Other confounding factors such as those affecting chest‐wall mechanics due to respiratory muscle weakness (27) and increased body mass index (28) typically cause a reduction in both vital capacity and FEV 1 , hence a restrictive ventilatory defect, and should be excluded before consideration of the diagnosis of BOS.…”

Section: Bronchiolitis Obliterans Syndrome (Bos)mentioning

confidence: 99%

Surrogate Markers and Risk Factors for Chronic Lung Allograft Dysfunction

Bowdish

Arcasoy

Wilt

et al. 2004

American Journal of Transplantation

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Obliterative bronchiolitis (OB) is the histologic correlate of chronic allograft dysfunction in pulmonary transplantation. The histologic diagnosis of OB is challenging, therefore a physiologic definition, bronchiolitis obliterans syndrome (BOS) based on pulmonary function tests has been used as a surrogate marker for OB for the last decade. BOS has proven to be the best available surrogate marker for OB and is predictive of the ultimate endpoints of graft and patient survival. Multiple other clinical markers have been reported and proposed as alternates for or complements to BOS grade, but all need further evaluation and validation in large, prospective clinical trials. Lastly, given the early occurrence and high incidence of chronic allograft dysfunction, the easily measurable endpoint of BOS grade, and our lack of understanding of ways to prevent or alter the course of BOS, lung transplant recipients represent an ideal population for clinical trials targeting prevention and treatment of chronic allograft dysfunction.

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Volume reduction of the native lung after single-lung transplantation for emphysema

Cited by 31 publications

References 3 publications

Model of Functional Restriction in Chronic Obstructive Pulmonary Disease, Transplantation, and Lung Reduction Surgery

Model of Functional Restriction in Chronic Obstructive Pulmonary Disease, Transplantation, and Lung Reduction Surgery

Hiperinsuflação pulmonar após transplante unilateral por enfisema

Surrogate Markers and Risk Factors for Chronic Lung Allograft Dysfunction

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