Original ArticlesCauses of allograft dysfunction after single lung transplantation for emphysema: extrinsic restriction versus intrinsic obstruction☆
Section snippets
Patients and methods
Of the 34 patients who underwent SLT for emphysema between 1990 and 1995, we studied 5 patients who subsequently presented with a clinical picture suggesting either BOS or extrinsic restriction (Table I). No patient had α1-antitrypsin deficiency. Three patients underwent left SLT, and two patients received a right-sided allograft. Long-term immunosuppression was maintained by a regimen of cyclosporine, azathioprine, and prednisone. Time from SLT to presentation ranged from 18 to 36 months.
Results
All five patients had dyspnea on exertion, hypoxemia, and severe airways obstruction (see Table I). Representative chest CT scans shown in FIGURE 1, FIGURE 2 demonstrated progressive native lung hyperinflation and volume loss of the allograft at the time of study compared to the immediate post -transplantation period. The patients had no evidence of active bacterial or cytomegaloviral pneumonia. There was no evidence of acute rejection on transbronchial biopsies, and all patients had patent
Discussion
In these five patients, the RLi appears to be a useful adjunct to the clinical history in distinguishing allograft dysfunction due predominantly to extrinsic restriction from that due to BOS in patients having undergone SLT for emphysema. Determination of the mechanism of allograft dysfunction after SLT for emphysema may allow selection of an appropriate subset of patients who would benefit from LVRS.
At presentation, the elevated RLi in all five patients may have been due to both severe
Acknowledgements
The authors thank Mary J. Connolly, Jennifer D. Rodenhouse, and Allison Smith for their assistance.
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Grant Support: This work was supported in part by NIH/NHLBI grants HL52586 and HL07633.