Evolving strategies in lung transplantation for emphysema

Abstract

Evolving strategies of pulmonary preservation, bronchial revascularization, immunosuppression, and infectious disease management were used in 15 initial consecutive patients undergoing lung transplantation for emphysema. There were 10 women and 5 men with a mean age of 49 years (range, 36 to 60 years). All patienta required supplemental oxygen therapy. One bilatoral, 9 left, and 5 right transplantations were performed. Mean preoperative forced expiratory volume In 1 second and total lung capacity were 16% and 146%, respectively, of predicted. Quadruple drug inununosuppresnon was used. Actuarial 1-year survival in this initial series is 93.3% ± 6.4% (Kaplan-Meier) with one early cardiac death at day 71. Mean forced expiratory volume in 1 second and diffusing capacity for carbon monoxide at discharge were 43% and 62%, respectively, of predicted. Rehabilitation has been excellent, and all survivors are active and free of supplemental oxygen. During the study, the following treatment strategies have evolved: (1) University of Wisconsin solution has replaced Euro-Collins' solution for pulmonary preservation; (2) direct bronchial revascularization with the internal thoracic artery now is used; (3) an algorithm-based variable dose OKT3 induction regimen has resulted in a major redaction in dosage; and (4) infectious disease management focuses on the prophylaxis of cytomegatovirus and fungal infection using prolonged gandclovir and early itraconazole therapy as well as the avoidance of Epstein-Barr virus mismatches. Single-lung transplantation for emphysema has excellent early results with continuing evolving management strattgies.