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Orthotopic Left Lung Transplantation in Rats
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Lung transplantation after lung volume reduction surgery.

Norihisa Shigemura1, Sebastien Gilbert, Jay K Bhama

  • 1Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA. shigemuran@upmc.edu

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Lung volume reduction surgery (LVRS) before lung transplantation increases post-operative complications and reduces functional capacity. While not impacting survival, LVRS should be carefully considered for transplant candidates.

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Area of Science:

  • Cardiothoracic Surgery
  • Pulmonary Medicine
  • Transplantation Medicine

Background:

  • Lung volume reduction surgery (LVRS) has been proposed as a bridge to lung transplantation since 1995.
  • Limited data exists on the risk-benefit tradeoffs of LVRS preceding lung transplantation.
  • Previous studies on LVRS have not thoroughly examined its impact on subsequent lung transplantation outcomes.

Purpose of the Study:

  • To evaluate the influence of prior LVRS on post-lung transplantation morbidity and mortality.
  • To compare outcomes of lung transplant recipients with and without prior LVRS.
  • To assess the impact of LVRS on functional capacity and survival after lung transplantation.

Main Methods:

  • A retrospective analysis of 177 patients undergoing lung transplantation for end-stage emphysema (2002-2009).
  • Comparison of 25 patients with prior LVRS (22 bilateral, 3 unilateral) against a matched cohort without prior LVRS.
  • Assessment of in-hospital morbidity, functional capacity (peak FEV1), and long-term survival.

Main Results:

  • Patients with prior LVRS experienced higher rates of postoperative bleeding and renal dysfunction requiring dialysis.
  • Post-transplantation peak FEV1 was significantly lower in the LVRS group (56.7% vs. 78.8%).
  • Five-year survival rates were similar between groups (59.7% with LVRS vs. 66.2% without LVRS).

Conclusions:

  • LVRS is a viable option as a bridge to lung transplantation for selected patients.
  • Prior LVRS can lead to increased morbidity and reduced functional capacity post-transplantation.
  • LVRS should not be universally recommended for all lung transplant candidates.