title: Lung volume reduction surgery in patients with emphysema and alpha-1 antitrypsin deficiency.
abstract: BACKGROUND
  The role of lung volume reduction surgery (LVRS) for individuals with alpha-1 antitrypsin (AAT) deficiency is unclear.
  
  
  METHODS
  To assess the role of LVRS in individuals with severe deficiency of AAT, outcomes within the National Emphysema Treatment Trial were analyzed.
  
  
  RESULTS
  Of 1218 randomized subjects, 16 (1.3%) had severe AAT deficiency (serum level < 80 mg/dL) and a consistent phenotype (when available). Characteristics of these 16 patients include 87.5% male; median serum AAT level, 55.5 mg/dL; age, 66 years; forced expiratory volume in 1 second (FEV1), 27% predicted; and 50% had upper-lobe-predominant emphysema. All 10 subjects randomized to LVRS underwent the procedure. Although the small number of subjects hampered statistical analysis, 2-year mortality was higher with surgery (20% versus 0%) than with medical treatment. Comparison of outcomes between the 10 AAT-deficient and the 554 AAT-replete subjects undergoing LVRS showed a greater increase in exercise capacity at 6 months in replete subjects and a trend toward lower and shorter duration FEV1 rise in deficient individuals.
  
  
  CONCLUSIONS
  This study extends to 49 cases the published experience of LVRS in severe AAT deficiency. Although the small number of subjects precludes firm conclusions, trends of lower magnitude and duration of FEV1 rise after surgery in AAT-deficient versus AAT-replete subjects and higher mortality in deficient individuals randomized to surgery versus medical treatment suggest caution in recommending LVRS in AAT deficiency.
authors.affiliation: Division of Medicine, Section of Respiratory Therapy, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. stollej@ccf.org
authors.forename: James K
authors.initials: JK
authors.lastname: Stoller
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Gildea
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Ries
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Meli
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Karafa
mesh_terms: D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D019896:alpha 1-Antitrypsin Deficiency / Q000503:physiopathology / Q000601:surgery*