Respiratory mechanics after heart-lung and bilateral lung transplantation

Abstract

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...

Transplant size mismatch in restrictive lung disease

“…However, a recent evidence‐based review from Barnard and colleagues demonstrated that the evidence for size matching is somewhat lacking and guidelines are not well defined . Most of the original studies examining this topic were very small case series with less than 100 patients, and although these studies provided recommendations on sizing, the number of patients examined limited them . Mason et al .…”

Effect of lung transplant and volume reduction surgery on respiratory muscle function

“…After bilateral grafting, total lung capacity (TLC) is unaffected by the disease of the recipient and by the size of the donor lung. By 6 mo after surgery, patients have TLC values that are within the range predicted for the recipient, even when there are large disparities between the donor's predicted TLC and the recipient's preoperative, or predicted, TLC (9,25,46,57). In contrast, the preoperative disease may influence values of functional residual capacity (FRC) and residual volume (RV) achieved after BLT or HLT.…”

“…Three studies of expiratory muscle strength after lung transplantation showed a reduction in maximal expiratory mouth pressure (MEP; Refs. 45,49,52), but four reported near-normal or normal values (1,9,10,34). More recently, a study in patients who had undergone HLT or BLT for cystic fibrosis demonstrated normal values of abdominal muscle strength assessed using a nonvolitional technique (magnetic stimulation of the lower thoracic nerve roots) (47).…”

“…Early studies in patients with heart-lung transplantation (HLT) reported markedly decreased maximal static inspiratory mouth pressure (MIP; Refs. 51,52), but many later studies in recipients of HLT (1,9,16,23,34,40) or bilateral lung transplantation (BLT; Refs. 9,34,40,50,61) found MIP values that were within normal limits, or only slightly reduced.…”

“…51,52), but many later studies in recipients of HLT (1,9,16,23,34,40) or bilateral lung transplantation (BLT; Refs. 9,34,40,50,61) found MIP values that were within normal limits, or only slightly reduced. Five of the six studies that assessed MIP in recipients of single grafts found normal values (10,34,40,45,61), but one reported a 40% reduction (49).…”