Abstractfor airway disease and pulmonary fibrosis are relatively minor. In this series the Background -Single lung transplantation native hyperinflated lung in chronic air-(SLT) is now a treatment option for way disease was not more disadvantageous patients with both pulmonary fibrosis and to overall function than the native lung in advanced chronic airway obstruction. pulmonary fibrosis. However, tests of lung Lung function after transplantation might function based on the terminal portion of be expected to be different in these two the forced spirogram are likely to be less groups of patients because of the effect of sensitive for the detection of obliterative the remaining native lung, but the imbronchiolitis in patients who have received plications of these differences have not a transplant for advanced airway obbeen fully explored.struction than in those with pulmonary Methods -The functional results of a stable fibrosis. population of 20 patients (13 chronic air- (Thorax 1998;53:43-49) way obstruction, seven pulmonary fibrosis) after SLT with no evidence of Keywords: lung transplantation, pressure-volume obliterative bronchiolitis were analysed.curves, moment analysis.The differences between the two populations in the interrelations between and determinants of total lung capacity (TLC), subdivisions of lung volume, airway func-Single lung transplantation (SLT) has been tion (spirometry, maximum expiratory successfully applied in patients with fibrotic flow volume curves, and moments analysis lung conditions 1-3 and, more recently, in of the spirogram), respiratory mechanics patients with advanced chronic airway ob-(PV curves and maximal respiratory pres-struction.4-11 It might be expected that lung sures), CO transfer factor (TLCO) and the function after SLT would be different in the distribution of perfusion, ventilation and two conditions as the native lung is small and volume of the transplanted and native shrunken in patients with pulmonary fibrosis lungs were compared.while in those with chronic airway obstruction Results -Total lung capacity after SLT it is likely to be severely hyperinflated in ad-(TLCpost) was normal in the patients with dition to having airway narrowing. In the early pulmonary fibrosis (mean (SE) 103.9 literature concern was expressed that in the (6.9)% predicted) but remained sig-latter situation function of the transplanted nificantly elevated in patients with airway lung may be compromised by the native lung obstruction (126.4 (4.4)%). Forced ex-which might show worsening hyperinflation piratory volume in one second (FEV 1 ) and with time.

Abstracthas been partly displaced by the more frequently used bilateral lung transplantation Background -The factors determining respiratory mechanics following heart-(BLT).2 3 HLT continues to be the treatment of choice for patients with irreversible damage lung transplantation (HLT) and bilateral lung transplantation (BLT) are in-of both organs, whilst BLT is used mainly in patients with chronic septic lung conditions completely understood. Methods -The dynamic and static lung with reversible right ventricular dysfunction.Data on static lung volumes after HLT and volumes of 15 patients after HLT (n=6) and BLT (n=9) with no evidence of ob-BLT have been conflicting and there is very limited information on other aspects of resliterative bronchiolitis were analysed to assess the factors which determine lung piratory mechanics after these procedures.A restrictive defect has been described in volumes following transplantation. Posttransplantation total lung capacity the first 2-4 postoperative months after transplantation. 4 5 This has been attributed to (TLCpost) was compared with the size of the recipient's lungs (TLCpre), the pre-the effects of the thoracotomy per se 6 and it recovers by six months after transplantation. 7 dicted capacity of the thorax of the recipient (TLCpred), and the predicted size After HLT some groups have reported that total lung capacity (TLC) tends to recover of the donor's lungs (TLCdon). In addition, the post-transplantation res-towards the recipient's preoperative value, 7 8 but others have reported values close to the piratory mechanics were investigated by measuring the static pressure-volume predicted normal TLC, 9 suggesting that the chest wall adapts to the transplanted lungs. (PV) curve of the lungs and the maximum respiratory pressures in a subgroup of nine After BLT the situation is potentially more complex as the chest wall has to adapt to two patients (four HLT, five BLT). Results -TLCpost was closely related to lungs anastomosed separately as well as to the effect of a bilateral thoracosternotomy or "clam TLCpred in both groups and showed no correlation with TLCpre. The mean (95% shell incision". Although size matching of the lungs of the recipient and donor is attempted, CI) TLCpost was 102.5 (90.2 to 115)% predicted for the recipient in the HLT group there is inevitably some disparity between the size of the donor lungs, the size of the lungs and 109 (97.6 to 120)% predicted for the recipient in the BLT group. Despite the removed, and the predicted normal capacity of the chest of the recipient. near normal TLC, residual volume (RV) and functional residual capacity (FRC) reIn this study we have analysed dynamic and static lung volumes after HLT and BLT in mained increased after transplantation in both groups. These abnormalities were not order to assess the factors which determine lung volumes after transplantation. In particular we attributable to either airflow obstruction or expiratory muscle weakness. On av-have compared the measured volumes after transplantation with...

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