Chest

Chest

Volume 103, Issue 2, February 1993, Pages 444-448
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Graft Position and Pulmonary Function After Single Lung Transplantation for Obstructive Lung Disease

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Single lung transplantation (SLT) has become a therapeutic option for the treatment of end-stage obstructive lung disease. Between January 1989 and June 1990, there were 14 patients with end-stage obstructive lung disease who underwent SLT. Eleven of these patients were surviving at 1 year following transplantation. Three of the patients had received left-sided SLT, and eight had received right-sided SLT. In the patients receiving left-sided SLT, the native right lung radiographically appeared to compress the left lung graft. In the patients receiving right-sided SLT, the native left lung did not appear to compress the right lung graft. We hypothesized that right SLT may provide a functional advantage over left SLT for patients with obstructive lung disease. We compared pulmonary function test results before and after transplantation (approximately 3 and 12 months) and compared quantitative ventilation-perfusion lung scan results between the patients with left SLT and those with right SLT. Additionally, we compared graded-exercise test results at 3 and 12 months after transplant between the two groups. Our data revealed no statistical difference in pulmonary function test results or graded-exercise test results between the two groups, although patients undergoing right SLT showed greater increases in FEV1 and forced vital capacity than those undergoing left SLT. Quantitative ventilation and perfusion were greater to the graft in patients receiving right-sided SLT than in patients receiving left-sided SLT, most likely due to the larger size of the right lung. We conclude that there is no functional difference between patients undergoing left or right SLT for end-stage obstructive lung disease.

Section snippets

MATERIALS AND METHODS

Fourteen patients underwent transplantation for end-stage obstructive lung disease at UTHSC-SA in the 18-month period from January 1989 to June 1990. Patients with severe obstructive lung disease with either panlobular emphysema secondary to $aL,-antitrypsin deficiency or with centrilobular emphysema received SLT. Patients less than 60 years of age with an expected survival of less than 18 months and without evidence of pulmonary infections or significant extrapulmonary disease were selected.4

RESULTS

Table 2 shows pulmonary function and arterial blood gas data before transplantation and at approximately 3 months and 12 months following transplantation in the SLT-L and SLT-R groups. There were no significant differences in mean time following transplantation at the 3-month period after SLT (SLT-L, 3.4 ±1.4 months; SLT-R, 2.8 ± 1.0 months) or at the 12-month period after SLT (SLT-L, 12.8 ±0.9 months; SLT-R, 12.3 ±2.7 months). Prior to transplantation, the FEV1 was comparably reduced in both

DISCUSSION

Despite previous controversy surrounding the use of SLT for the treatment of end-stage obstructive lung disease, SLT for obstructive lung disease has been performed successfully.4, 7, 8, 9 Traditionally, SLT-L was preferable for technical reasons, such as a longer bronchial recipient stump and a larger recipient atrial cuff.3

Our center initially performed SLT for obstructive disease on the left side, but radiographically we noted significant compression of the transplanted left lung by the

REFERENCES (9)

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Presented in abstract form at the 56th annual Scientific Assembly, American College of Chest Physicians, Toronto, Canada, October 22-26, 1990.

Manuscript received May 8; revision accepted June 19.

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Copyright © 1993 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.