title: Diagnosis of unilateral mainstem bronchial obstruction following single-lung transplantation with routine spirometry.
abstract: Single-lung transplantation has become a treatment option for many patients with advanced pulmonary disease. Recent advances in surgical technique and refined immunosuppressive regimens have led to improvement in long-term outcomes, but postoperative complications, including airway disorders, remain problematic. Serial spirometry with flow-volume loops is sensitive in detecting early small-airway disease associated with lung allograft rejection or bronchiolitis obliterans, but its role in the diagnosis of large-airway disease in the posttransplantation setting has not been delineated. In this report, we describe a novel alteration in the configuration of the flow-volume loop in a patient who developed unilateral mainstem bronchial obstruction following single-lung transplantation for severe emphysema. Surveillance spirometry performed 6 weeks after transplantation demonstrated a new initial plateau in the maximal expiratory flow-volume curve suggestive of a variable intrathoracic airway obstruction. This unique aberration in the flow-volume curve sheds new insight into the physiologic abnormalities of spirometry in patients receiving lung transplants.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor 48109-0360.
authors.forename: G R
authors.initials: GR
authors.lastname: Neagos
authors.forename: F J
authors.initials: FJ
authors.lastname: Martinez
authors.forename: G M
authors.initials: GM
authors.lastname: Deeb
authors.forename: R L
authors.initials: RL
authors.lastname: Wahl
authors.forename: M B
authors.initials: MB
authors.lastname: Orringer
authors.forename: J P
authors.initials: JP
authors.lastname: Lynch
mesh_terms: D000208:Acute Disease; D001982:Bronchial Diseases / Q000175:diagnosis* / Q000209:etiology; D003251:Constriction, Pathologic; D005541:Forced Expiratory Volume; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008449:Maximal Expiratory Flow-Volume Curves; D008875:Middle Aged; D013147:Spirometry; D014797:Vital Capacity