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(Chest. 2001;119:163-168.)
© 2001 American College of Chest Physicians

Maximal Expiratory Flow Patterns After Single-Lung Transplantation in Patients With and Without Chronic Airways Obstruction*

Yuri Villaran, MD, FCCP{dagger}; Michael E. Sekela, MD, FCCP{dagger} and Nausherwan K. Burki, MD, PhD, FCCP

* From the Division of Pulmonary and Critical Care Medicine (Drs. Villaran and Burki), and Department of Cardiothoracic Surgery (Dr. Sekela), University of Kentucky Medical Center, Lexington, KY. {dagger} Currently in private practice in Lexington, KY.

Correspondence to: Nausherwan K Burki, MD, PhD, FCCP, Division of Pulmonary and Critical Care Medicine, University of Kentucky Medical Center, MN614, 800 Rose St, Lexington, KY 40536-0298

Background: A biphasic-plateau pattern in the maximal expiratory flow-volume (MEFV) curve has been described after single-lung transplantation (SLT) in patients with chronic airways obstruction (CAO). It has been theorized that this pattern is either related to stenosis at the anastomotic or subanastomotic site, or the sum of the airflow contribution from the native lung with airways obstruction and transplanted lung.

Subjects and methods: We analyzed data in 16 patients with CAO who had undergone transplantations (5 men, 11 women; mean age [± SD], 53.8 ± 4.9 years), and 9 patients with pulmonary vascular disease (PVD) without airways obstruction who had undergone transplantations (2 men, 7 women; mean age, 35.4 ± 11.4 years).

Results: In the patients with PVD, there were no significant changes in static or dynamic lung volumes or in the MEFV curve after SLT. In the patients with CAO, indexes of airways obstruction improved significantly after SLT, and the typical biphasic-plateau pattern developed in the MEFV curve. In one patient with CAO who required pneumonectomy of the native lung after SLT, the biphasic pattern was absent.

Conclusions: These results support the view that this MEFV pattern is a result of airflow from the native and transplanted lungs in patients with CAO. In addition, the results show that in patients with no prior airways obstruction, SLT does not alter static or dynamic lung volumes or maximal expiratory flow rate.

Key Words: airways resistance • flow-volume curves • lung transplantation • pulmonary time constants




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