Effect of bilateral lung transplantation on excessive dynamic airway collapse

Excessive dynamic airway collapse (EDAC) is associated with significant respiratory morbidity. It has been hypothesized that EDAC may limit the benefits of lung transplantation in chronic obstructive pulmonary disease (COPD) patients. We aim to find the effect of bilateral lung transplantation on EDAC in COPD patients.

Retrospective chart review was performed to identify patients with concomitant presence of COPD and EDAC before undergoing bilateral lung transplantation from December 2011 to December 2014. Pre- and post-transplant pulmonary function tests, flow-volume (FV) loops, computed tomography (CT) of the chest, and flexible bronchoscopies were studied.

A total of 165 patients underwent bilateral lung transplantation during the study period. Eight patients had COPD and EDAC prior to the transplant. Post-transplantation, 7 out of 8 patients showed resolution of EDAC on expiratory CT chest and 1 patient did not have post-transplant CT chest. All eight showed no EDAC on post-transplant surveillance bronchoscopy. Post-transplant, mean predicted FEV1/FVC increased from 37% to 117% and mean predicted FEV1 increased from 20% to 61%.

There is resolution of EDAC post-bilateral lung transplantation in this retrospective COPD patient population. EDAC should not be considered as a benefit-limiting factor to bilateral lung transplantation. However, prospective studies are required to explore potential indication.