title: Ventilation-perfusion inequalities during graft rejection in patients undergoing single lung transplantation for primary pulmonary hypertension.
abstract: We report herein data on single lung transplant (SLT) recipients with primary pulmonary hypertension (PPH). One patient did well following surgery but died on the 30th postoperative day due to cytomegalovirus pneumonia. The remaining two patients initially did well with unlimited exercise tolerance following transplantation, but then developed marked dyspnea on exertion and hypoxemia on postoperative days 144 and 120, respectively. Pulmonary function testing showed marked deterioration of function and transbronchial lung biopsy specimens revealed acute graft rejection in one patient and evidence of chronic graft rejection in the second patient. Quantitative ventilation-perfusion lung scanning demonstrated a marked decrease in ventilation to the transplanted lung in both cases associated with only a mild decrease in perfusion. This V/Q mismatch resulted in markedly decreased arterial oxygen saturations, widened alveolar-arterial oxygen gradients, and clinically debilitating dyspnea. We conclude that rejection may result in significant V/Q mismatch and hypoxemia in PPH patients undergoing SLT, which may limit the use of this specific type of surgery for PPH.
authors.affiliation: Department of Medicine (Division of Pulmonary Diseases), University of Texas Health Science Center, San Antonio.
authors.forename: S M
authors.initials: SM
authors.lastname: Levine
authors.forename: S G
authors.initials: SG
authors.lastname: Jenkinson
authors.forename: C L
authors.initials: CL
authors.lastname: Bryan
authors.forename: A
authors.initials: A
authors.lastname: Anzueto
authors.forename: C A
authors.initials: CA
authors.lastname: Zamora
authors.forename: W J
authors.initials: WJ
authors.lastname: Gibbons
authors.forename: J H
authors.initials: JH
authors.lastname: Calhoon
authors.forename: J K
authors.initials: JK
authors.lastname: Trinkle
mesh_terms: D005260:Female; D006084:Graft Rejection; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008168:Lung / Q000000981:diagnostic imaging; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D011877:Radionuclide Imaging; D015656:Respiratory Mechanics; D014692:Ventilation-Perfusion Ratio
chemical_list: D010100:Oxygen