Lung Volume Reduction Surgery following Single-Lung Transplantation

Abstract

Although single-lung transplantation is an established therapy for respiratory failure secondary to emphysema, hyperinflation of the native lung with concomitant compression of the transplanted lung is emerging as a cause of morbidity. In non-transplant emphysematous patients with hyperinflated lungs, pneumectomy was found to improve pulmonary function and quality of life. We report our experience on 5 single-lung transplant recipients with emphysema who underwent lung volume reduction surgery (pneumectomy, bullectomy, or anatomic resection) following transplantation. There were no perioperative deaths. Three patients underwent lung volume reduction because of a progressive symptomatic decline in pulmonary function that was thought to be secondary to hyperinflation of the native lung. Two of these patients had a sustained improvement in lung function and functional status over several years. Two other patients underwent lung volume reduction for removal of suspicious pulmonary nodules in the native lung. Both patients had a subsequent improvement in forced expiratory volume in one second. In our experience, lung volume reduction surgery after single-lung transplantation in emphysematous patients was a safe means of providing long-term improvement in pulmonary function.