title: Lung transplantation after endoscopic lung volume reduction.
abstract: BACKGROUND
  Endoscopic lung volume reduction (ELVR) has become an established treatment option in selected patients with end-stage lung emphysema. ELVR, however, does not always prevent disease progression, and patients may inevitably be considered for lung transplantation.
  
  
  OBJECTIVE
  Currently, limited data exist regarding the impact of preceding ELVR on lung transplantation outcomes.
  
  
  METHODS
  A retrospective, single-center analysis of lung transplantation (LTx) waiting list candidates, who had previously undergone ELVR for emphysema between 2010 and 2014, was performed. Outcomes were compared to matched (1:2) controls who underwent LTx for emphysema without previous ELVR. The 12-month survival after LTx represented the primary end point.
  
  
  RESULTS
  In total 23/693 (3%) patients listed for LTx between January 2010 and May 2014 had undergone ELVR, of whom 20/23 (87%) proceeded to LTx (ELVR group). Forty matched non-ELVR emphysema patients acted as controls. Bronchiectasis on CT prior to LTx was more evident in ELVR patients [11/20 (55%) vs. 12/40 (30%); p = 0.04] as well as airway colonization after LTx [10/20 (50%) vs. 6/40 (15%); p = 0.004]. Among ELVR patients, the most prevalent colonizing organism was Stenotrophomonas maltophilia (4/10 patients, 40%). No significant differences were observed in LTx waiting list time, duration of LTx procedure, ventilatory support, ICU stay after LTx or time to hospital discharge. One ELVR patient (5%) died 189 days after LTx from pneumonia, compared to 1 non-ELVR patient (3%) who died after 269 days (p = 0.61).
  
  
  CONCLUSIONS
  Previous ELVR treatment was not associated with differing outcomes following LTx. Increased bacterial colonization rates were evident and warrant further investigation.
authors.affiliation: Department of Respiratory Medicine, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fuehner
authors.forename: Carolina
authors.initials: C
authors.lastname: Clajus
authors.forename: Jan
authors.initials: J
authors.lastname: Fuge
authors.forename: Danny
authors.initials: D
authors.lastname: Jonigk
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Mark
authors.initials: M
authors.lastname: Greer
authors.forename: Jens
authors.initials: J
authors.lastname: Gottlieb
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011379:Prognosis; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D014850:Waiting Lists