Quantitative evaluation of native lung hyperinflation after single lung transplantation for emphysema using three-dimensional computed tomography volumetry.
OBJECTIVE
Although double lung transplantation is performed more frequently for emphysema, single lung transplantation (SLT) continues to be performed owing to limited donor organ availability. Native lung hyperinflation (NLH) is a unique complication following SLT for emphysema. Three-dimensional computed tomography (3D-CT) volumetry has been introduced into the field of lung transplantation, which we used to assess NLH in emphysema patients undergoing SLT. The primary purpose of this study was to confirm the effectiveness of 3D-CT volumetry in the evaluation of NLH following SLT for emphysema.


METHODS
In 5 emphysema patients undergoing SLT at Kyoto University Hospital, 3D-CT volumetry data, pulmonary function test results, and clinical and radiological findings were retrospectively evaluated.


RESULTS
Three patients did not develop a significant mediastinal shift, whereas the other 2 patients developed a mediastinal shift. In the 3 patients without a mediastinal shift, 3D-CT volumetry did not show a significant increase in native lung volume. These patients had a history of sternotomy prior to lung transplantation and firm adhesion on the mediastinal side was detected during lung transplantation. One of 2 patients with a mediastinal shift developed severe dyspnea with significantly decreased pulmonary function, and 3D-CT volumetry showed a significant increase in the native lung volume. However, the other patient did not show any dyspnea and his native lung volume decreased postoperatively (preoperatively to 6 months postoperatively: +981 mL and -348 mL, respectively).


CONCLUSIONS
Although bilateral lung transplantation has become preferable for emphysema patients owing to postoperative NLH with SLT, patients with a history of sternotomy prior to lung transplantation might be good candidates for SLT. 3D-CT volumetry may be a useful method for detection of NLH.
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
H
H
Motoyama
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. Electronic address: fengshic@kuhp.kyoto-u.ac.jp.
F
F
Chen
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
A
A
Ohsumi
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
K
K
Hijiya
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
M
M
Takahashi
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
K
K
Ohata
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
T
T
Yamada
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
M
M
Sato
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
A
A
Aoyama
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
T
T
Bando
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
H
H
Date
D004646:Emphysema / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*