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Lung transplantation following lung volume reduction surgery
W Wisser1, E Deviatko, N Simon-Kupilik
1Department of Cardiothoracic Surgery, University of Vienna, Austria.
Summary
Lung volume reduction surgery (LVRS) can delay the need for lung transplantation (LTX) and improve outcomes for some emphysema patients. However, those not responding to LVRS face higher risks during subsequent lung transplantation.
Area of Science:
- Pulmonology
- Thoracic Surgery
- Transplant Surgery
Background:
- Lung volume reduction surgery (LVRS) is explored as an alternative to lung transplantation (LTX) for end-stage emphysema.
- The long-term efficacy and role of LVRS as a bridge to or replacement for LTX remain under investigation.
Purpose of the Study:
- To analyze the clinical course and outcomes of patients who underwent LVRS followed by LTX.
- To evaluate the impact of LVRS response on subsequent LTX outcomes.
Main Methods:
- A cohort of 15 patients who underwent LVRS between 1994 and 1998 and subsequently LTX was analyzed.
- Patients were categorized into responders and non-responders based on FEV(1) improvement post-LVRS.
- Lung function and clinical outcomes were assessed before and after LVRS and LTX.
Main Results:
- LVRS improved FEV(1) in 47% of patients (responders), but this improvement declined over time.
- Non-responders (53%) showed no significant FEV(1) improvement post-LVRS.
- Following LTX, FEV(1) significantly improved in all patients (p < 0.001).
- The 3-month mortality post-LTX was 20%, with all deaths occurring in the non-responder group.
- Overall mortality post-LTX was 13.3% (2 patients).
Conclusions:
- Successful LVRS can delay LTX and potentially improve conditions for transplantation.
- Patients who do not respond functionally to LVRS face a significantly higher perioperative risk during subsequent LTX.