Bronchoscopic lung volume reduction as a bridge to lung transplantation in patients with chronic obstructive pulmonary disease.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is the leading indication for lung transplantation; however, these patients rarely gain priority on the waiting list until very late. The clinical status can be improved by surgical lung volume reduction; this procedure, although carries significant morbidity, has been repeatedly advocated as a bridge. Recently, bronchoscopic lung volume reduction (BLVR) has been proposed to improve functional parameters in patients with emphysema; however, it has never been reported as a bridge to lung transplantation so far.


METHODS
We hereby report our experience with BLVR as a bridge to lung transplantation in four patients (males, mean age 51 years).


RESULTS
All patients underwent unilateral BLVR (two right upper lobe (RUL), one right lower lobe (RLL), and one left upper lobe (LUL); mean 3.5 valves per patient). No morbidity and mortality were observed. Three out of the four patients successfully reached transplantation after 6, 7, and 6 months, respectively. Two patients received single-lung transplantation and one sequential double-lung transplantation. The fourth patient died of respiratory failure 13 months after valve placement. BLVR was able to reduce the residual volume and improve the 6-min walking test and Medical Research Council (MRC) score.


CONCLUSIONS
BLVR allowed to improve the functional status and quality of life of these patients. In a selected group of COPD patients awaiting lung transplantation, the reported short- to medium-term objective improvement may play an important role to ameliorate the clinical status and reach the time of surgery.
Venuta
Federico
F
Department of Thoracic Surgery, University of Rome Sapienza - Policlinico Umberto I, Rome, Italy. federico.venuta@uniroma1.it
Diso
Daniele
D
Anile
Marco
M
De Giacomo
Tiziano
T
Rendina
Erino A
EA
Rolla
Matilde
M
Ricella
Chiara
C
Coloni
Giorgio F
GF
D000328:Adult; D001999:Bronchoscopy / Q000379:methods*; D018450:Disease Progression; D005541:Forced Expiratory Volume; D006801:Humans; D008137:Longitudinal Studies; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D012115:Residual Volume; D016896:Treatment Outcome; D014850:Waiting Lists
D010100:Oxygen