Respiratory insufficiency relapse three years after single lung transplantation for emphysema successfully treated by native lung volume reduction

Respiratory insufficiency can recur after lung transplantation. This is usually due to acute rejection (AR), bronchiolitis obliterans (BO) or chronic infection (CI). An uncommon cause carl be native lung disease progression. A patient underwent left single lung transplant for pulmonary emphysema oil March 1991. After a complicated post-operative course he was discharged without supplemental oxygen. During the follow-up, three episodes of AR were discovered by transbronchial biopsies and successfully treated. Three years after the transplant the patient complained recurrence of dyspnea. No AR, BO or CI was evident In June 1995 the patient had to be intubated and ventilated for transplanted lung pneumonia. Separate lung ventilation with positive pressure to the transplanted lung was necessary to achieve satisfactory exchange. However, at every effort to ventilate the patient with a single lumen tube hyper-inflation of the transplanted lung reappeared and gas exchange decreased. The patient was therefore submitted to surgical volume resection of the 30% of tile native lung including some large bullae. Six days after the operation the patient tolerated a single lumen ventilation and was then extubated. The patient was discharged with a satisfactory respiratory function and without supplemental oxygen.