Does hyperexpansion of the native lung adversely affect outcome after single lung transplantation for emphysema? Preliminary findings.

RATIONALE AND OBJECTIVES

The authors evaluated the effect of the native emphysematous lung on graft function after single lung transplantation.

MATERIALS AND METHODS

Thirty-two patients who underwent single lung transplantation were examined with radiography preoperatively for degree of emphysema and postoperatively for hyperexpansion of the native lung. All patients underwent ventilation-perfusion scanning before transplantation and ventilation scanning after transplantation. Pulmonary function tests and measurement of arterial partial pressure of oxygen were also measured before and after surgery. The postoperative course was graded on a subjective scale.

RESULTS

Hyperexpansion of the native lung was seen in 16 of the 32 patients in the postoperative period. On the basis of serial measurements of forced expiratory volume in 1 minute, these patients fared poorly in the postoperative period compared with patients without hyperexpansion. Pulmonary blood flow to the native lung, as measured with perfusion scintigraphy, paradoxically increased in 11 patients after transplantation. Nine of these 11 patients demonstrated hyperinflation of the native lung, suggesting that graft compression adversely affects blood flow to the transplanted lung.

CONCLUSION

Hyperexpansion of the native lung after single lung transplantation for emphysema may have a deleterious effect on graft function and possibly on clinical outcome.