Regional Ventilation and Perfusion after Lung Transplantation in Patients with Emphysema

Stevens, Paul; Johnson, Philip C.; Bell, Robert L.; Beall, Arthur C.; Jenkins, Daniel E.

doi:10.1056/nejm197001292820504

Cited by 113 publications

(30 citation statements)

References 8 publications

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“…Initially, it was proposed that patients should receive a doublelung transplant owing to the risk of ventilation/perfusion alterations associated with single-lung transplants. The high vascular resistance and static compliance of the native emphysematous lung lead to a rapid increase in perfusion of the newly-implanted lung, up to 70% of the total, and a decrease in its ventilation, up to 30% of the total [9].…”

Section: Discussionmentioning

confidence: 99%

Lung transplantation for emphysema. Lung hyperinflation: incidence and outcome

et al. 2005

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Lung transplantation, single or bilateral sequential, is the final option for patients with emphysema. This study analyzed the outcome of lung transplants for emphysema (single or double), and evaluates the incidence, predictive factors and prognosis of lung hyperinflation (LHI) in unilateral transplants. We prospectively studied patients undergoing lung transplantation for emphysema. On admission to the Intensive Care Unit (ICU) and at 12, 24, 48 and 72 h we tested the patients' respiratory function, oxygen arterial pressure (PaO2) and mean pulmonary arterial pressure (MPAP) before transplantation. LHI incidence, duration of mechanical ventilation and hypoxemia, ICU stay and mortality was also analyzed. We studied 34 consecutive patients undergoing lung transplantation for emphysema, 14 single and 20 bilateral. Single-lung transplantation had a higher mortality (50%) than double-lung transplantation (11%), with an odds ratio of 9.0 (1.3-48.7). Of the 14 patients who received a single graft, 9 patients (64%) developed LHI. No predictive factors for LHI could be established. Duration of mechanical ventilation (22 vs 3 days) and ICU stay (36 vs 6 days) was much longer in patients with LHI; however, only ICU stay reached statistical significance (P = 0.011). Mortality in patients with LHI was higher, 67% vs 20% (NS). We conclude that single-lung transplant in emphysema patients has a worse prognosis than bilateral transplant, with a 9-fold higher mortality rate. LHI is a common event in single-lung transplant for emphysema and is associated in our patients with a longer stay at the ICU.

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Section: Discussionmentioning

confidence: 99%

Lung transplantation for emphysema. Lung hyperinflation: incidence and outcome

et al. 2005

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“…Initially it was believed that single lung transplantation (SLT) was contraindicated in COPD patients due to concerns that it would lead to severe ventilationperfusion mismatch and progressive hyperinflation of the highly compliant native lung. 46 Subsequent studies refuted these concerns, and SLT emerged as the most commonly performed procedure for this patient population. 6 More recently, there has been an increasing trend towards utilization of bilateral lung transplantation (BLT), particularly for younger patients with COPD or ␣-1 antitrypsin deficiency.…”

Section: Choice Of Surgical Proceduresmentioning

confidence: 99%

Lung Transplantation for Chronic Obstructive Pulmonary Disease

Sager

Kotloff

2007

Clinical Pulmonary Medicine

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Given its high prevalence and propensity to cause disabling disease, it is not surprising that COPD represents the most common indication worldwide for lung transplantation, accounting for nearly half of all lung transplant procedures. Despite over 4 decades of experience with this procedure in the COPD population, a number of important clinical issues remain unresolved. This article provides an overview of lung transplantation, with special emphasis on issues unique to the COPD population.

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“…Patient survival immediately postoperatively, followed by reports of increasing lengths of time out of hospital became the key reported outcome variables. Earlier on, however, reference was made to physiological effects including the ability of the transplanted lung to support gas exchange, and interestingly an understanding of potential complications of two different lungs with quite different mechanical properties as occurs in single lung transplantation for emphysema [10].…”

Section: Survivalmentioning

confidence: 99%

Role of Cardiopulmonary Exercise Testing in Lung and Heart-Lung Transplantation

Williams¹,

Slater²

2002

Clinical Exercise Testing

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Lung transplantation has evolved over the last 2 decades as an important treatment option for severe pulmonary and pulmonary vascular disease. Initially, survival and duration of survival were the only outcome measures measured. Function outcomes including cardiopulmonary exercise testing have only more recently been reported. Exercise capacity seems to correlate very poorly with measured lung function, but early onset lactic acidosis and premature exercise termination at a substantially reduced VO 2 peak are seen almost universally. Cardiac and ventilatory limitation are only sporadically seen. It appears that peripheral muscle dysfunction due to pre-and posttransplant factors is the most frequent cause of exercise limitation. Although clear criteria for exercise testing of lung transplant recipients have yet to be developed, cardiopulmonary exercise testing (CPET) will help clarify the degree and mechanism of exercise limitation, aiding decision making as to the timing of transplantation. Furthermore, posttransplantation the assessment of vocational and exercise capacity as well as detection of allograft dysfunction can be greatly aided by CPET.

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Regional Ventilation and Perfusion after Lung Transplantation in Patients with Emphysema

Cited by 113 publications

References 8 publications

Lung transplantation for emphysema. Lung hyperinflation: incidence and outcome

Lung transplantation for emphysema. Lung hyperinflation: incidence and outcome

Lung Transplantation for Chronic Obstructive Pulmonary Disease

Role of Cardiopulmonary Exercise Testing in Lung and Heart-Lung Transplantation

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