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Chest, Vol 99, 533-537, Copyright © 1991 by American College of Chest Physicians

ARTICLES

Treatment of end-stage chronic obstructive pulmonary disease with double lung transplantation

RW Emery, JL Graif, K Hale, F Eales, TJ Von Rueden, MR Pritzker, K Love and KV Arom
Division of Cardiothoracic Transplantation, Minneapolis Heart Institute/Abbott Northwestern Hospital.

Six patients with end-stage emphysema (age 44 +/- 2 years) underwent double lung transplantation (Tx) from June 1988 through May 1990. All suffered from severe inanition and required oxygen therapy. The ischemic time was 193 +/- 28 minutes. Post-Tx immune suppression was OKT3 (14 days), cyclosporine (trough levels of 150 +/- 25 ng/ml), azathioprine to keep WBC at 3,000 to 5,000/cu mm (1 to 3.0 mg/kg/day) and following OKT3, a tapering prednisone regimen. Two rejection episodes that occurred in two patients on post-Tx day 5 and 10 were treated with bolus doses of methylprednisolone. The mean hospital stay was 32 +/- 7 days (range, 20 to 69 days). Four patients required treatment of cytomegalovirus (CMV) infection: gastritis (+donor, +recipient) in one and CMV pneumonia in two (+donor, -recipient). A fourth (+donor, -recipient) had right-sided Candida empyema six weeks post-Tx, developed CMV and staphylococcal sepsis, and died 64 days post- Tx. One patient required pyloroplasty eight weeks post-Tx and one patient underwent tracheal suture line repair at eight weeks. During a follow-up of 81 patients months (range, 8 to 24 months), one patient had developed Epstein-Barr viral (EBV) induced lymphoproliferative disease in the lung and one patient had developed EBV lymphoma. Three patients are at work, one is continuing rehabilitation, and one is at home. Double lung Tx offers a definitive benefit to patients with emphysema; however, a prolonged postoperative course can be expected. Viral infections remain serious but treatable problems.


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 Ann. Thorac. Surg.Home page
K. S. Naunheim and M. K. Ferguson
The Current Status of Lung Volume Reduction Operations for Emphysema
Ann. Thorac. Surg., August 1, 1996; 62(2): 601 - 612.
[Abstract] [Full Text]


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Copyright © 1991 by the American College of Chest Physicians.