Successful lung transplantation following lung volume reduction surgery

Background: Lung volume reduction surgery (LVRS) is an accepted treatment modality for patients with advanced emphysema. Recently, successful lung transplantation (LTX) has been reported following LVRS. We assess the pulmonary functions in lung transplant recipients after LVRS. Methods: 8 patients-5 males and 3 women-aged 53-66 years with advanced emphysema underwent LVRS. Following clinical deterioration and decline of pulmonary function, patients underwent single LTX. Post transplantation follow-up included pulmonary function, 6 minute walk distance (6MWD) and recording perioperative complications. Results: Median forced expiratory in one second (FEV1) before and after LVRS were 24% with 31% predicted, respectively. All but one showed improvement in lung function and 6MWD following LVRS. Median maximal 6MWD before and after LVRS was 222 and 316 meters, respectively. Median time from LVRS to LTX was 46 months (range 10-83). All patients survived and were discharged after LTX. Median FEV1 before and after LTX was 23% with 57% predicted, respectively. Median 6MWD before and after LTX was 240 and 462 meters, respectively. NYHA classes improved from 3-4 to 1-2 in 7 surviving patients. At transplantation, bleeding due to pleural adhesions was observed in 4 patients; two required blood transfusions. One patient developed acute respiratory distress syndrome and one had unilateral vocal cord paralysis. At nine-month follow-up, 7 patients are doing remarkably well, while one patient died 6 months after LTX due to bronchiolitis obliterans syndrome (BOS). Conclusions: LVRS is a therapeutic option in patients with end-stage emphysema. When emphysema deteriorates, LTX can be successfully performed with significant improvement of quality of life without significant additional risk.