title: Native lung volume reduction surgery relieves functional graft compression after single-lung transplantation for chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Single-lung transplantation is an accepted treatment for end-stage lung disease caused by chronic obstructive pulmonary disease. A complication unique to single-lung transplantation for chronic obstructive pulmonary disease is graft dysfunction due to compression caused by native lung hyperinflation. We hypothesized that patients with functional compromise from native lung hyperinflation would benefit from native lung volume reduction surgery.
  
  
  METHODS
  The charts of all patients undergoing single-lung transplantation for chronic obstructive pulmonary disease were reviewed for lung volume reduction surgery of their native lung. Data regarding length of stay, surgical morbidity and mortality, overall survival, type of lung volume reduction surgery, and pulmonary function were recorded to evaluate the effect of lung volume reduction surgery.
  
  
  RESULTS
  Between February 1992 and May 2007, 206 single-lung transplantations were performed for chronic obstructive pulmonary disease. Ten (5%) patients had clinically significant graft compression from native lung hyperinflation. After excluding other causes for functional decline, these patients underwent a modified lung volume reduction surgery between 12 and 142 months after single-lung transplantation (mean, 50 months). Lung volume reduction surgery consisted of anatomic resection. Two (20%) of 10 patients died during their hospitalization. Of the remaining 8 patients, 7 (87.5%) have demonstrated functional improvement on the basis of forced expiratory volume in 1 second improving from 12% to 200% (mean improvement, 57%). Within 6 months of lung volume reduction surgery, mean 6-minute walk values improved significantly (866 to 1055 feet), whereas desaturation with exertion decreased significantly.
  
  
  CONCLUSIONS
  Lung volume reduction surgery by means of formal lobectomy in patients with native lung hyperinflation undergoing single-lung transplantation and significant graft compression appears feasible. Additionally, improvements in forced expiratory volume in 1 second can be accomplished in nearly all properly selected patients. Lung volume reduction surgery should be considered in patients with decreasing graft function caused by graft compression from native lung hyperinflation.
authors: Division of Cardiothoracic Surgery, University of Colorado Health Sciences Center, Denver, Colo, USA.
authors: T Brett
authors: TB
authors: Reece
authors: John D
authors: JD
authors: Mitchell
authors: Martin R
authors: MR
authors: Zamora
authors: David A
authors: DA
authors: Fullerton
authors: Joseph C
authors: JC
authors: Cleveland
authors: Marvin
authors: M
authors: Pomerantz
authors: Dennis M
authors: DM
authors: Lyu
authors: Frederick L
authors: FL
authors: Grover
authors: Michael J
authors: MJ
authors: Weyant
mesh_terms: D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation