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Expiratory flow pattern following single-lung transplantation in emphysema
J P Herlihy1, J G Venegas, D M Systrom
1Lung Transplantation Program, Massachusetts General Hospital, Boston 02114.
American Journal of Respiratory and Critical Care Medicine
|December 1, 1994
Summary
Maximal expiratory flow volume curves (MEFV) in single lung transplant (SLT) recipients with emphysema often show a biphasic pattern and plateau. These findings do not necessarily indicate anastomosis pathology, but rather reflect the differing functions of the transplanted and native lungs.
Area of Science:
- Pulmonary Medicine
- Thoracic Surgery
- Respiratory Physiology
Background:
- Maximal expiratory flow volume curve (MEFV) patterns, specifically "plateau" and "biphasic" shapes, have been traditionally associated with anastomosis pathology in single lung transplantation (SLT) recipients.
- However, theoretical models suggest these patterns may arise in SLT recipients with emphysema due to inherent physiological limitations, independent of surgical complications.
Observation:
- A review of ten SLT recipients with emphysema revealed that all exhibited both biphasic MEFV curves and plateaus.
- Crucially, none of these patients displayed any clinical or diagnostic evidence of anastomosis pathology.
- Independent lung spirometry, utilizing a novel technique, was performed to differentiate the contribution of each lung to the overall MEFV.
Findings:
- The initial high-flow phase of the biphasic MEFV originated from the transplanted lung.
- The subsequent low-flow phase originated from the native, emphysematous lung.
- Flow limitation was localized immediately downstream of the anastomosis, indicating a physiological consequence rather than a surgical defect.
Implications:
- The presence of a biphasic MEFV and plateau in SLT recipients with emphysema is a common physiological finding, not necessarily indicative of anastomosis pathology.
- This understanding can help clinicians differentiate between normal post-transplant physiology and actual surgical complications, improving patient management.
- The findings highlight the importance of advanced spirometry techniques in accurately assessing lung function after transplantation.