Lung Transplantation for Chronic Obstructive Pulmonary Disease - 05/09/11
Riassunto |
In 1970, a report in the New England Journal of Medicine demonstrated that single lung transplantation for advanced pulmonary emphysema was technically possible but raised serious questions as to whether the procedure was physiologically feasible.112 In two patients with advanced pulmonary emphysema, the authors observed hyperinflation of the native emphysematous lung with concomitant reduced volume and ventilation to the transplant lung despite persistence of high pulmonary blood flow. The authors concluded that “patients with emphysema may be poor candidates for lung transplantation.”112 Fourteen years later, after successful single lung transplantation for pulmonary fibrosis,118 thoracic surgeons revisited the question of lung transplantation for pulmonary emphysema.28, 64, 80 Physicians now understand that the two earliest transplant recipients for emphysema died because of diffuse pneumonitis in the transplanted lung, and that gross ventilation–perfusion imbalances after single lung transplantation for such patients are not physiologically inevitable nor insurmountable. Nevertheless, as discussed in this article, many of the concerns raised in 1970 are still relevant, especially hyperinflation of the native lung after surgery and ventilation–perfusion imbalance that may occur when the transplanted lung develops pneumonia or chronic rejection.
Several excellent general reviews of lung transplantation have been published recently in which the surgical techniques and postoperative management are discussed in detail.7, 119 This article focuses specifically on lung transplantation for advanced chronic obstructive pulmonary disease (COPD). The discussion is divided into five broad categories:
1 | Optimal candidate selection |
2 | Physiology of the transplanted lung |
3 | Benefits and risks and of lung transplantation |
4 | Single lung versus bilateral lung transplantation |
5 | Relationship between lung transplantation and lung volume reduction surgery |
Mappa
| Address reprint requests to Larry L. Schulman, MD, College of Physicians and Surgeons, Columbia University, Cardiopulmonary Transplant, PH 14 West, 622 West 168th Street, New York, NY 10032, e-mail: LLS2@columbia.edu |
Vol 21 - N° 4
P. 849-865 - dicembre 2000 Ritorno al numero
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- Lung Volume Reduction Surgery for Emphysema
- Kevin R. Flaherty, Fernando J. Martinez
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