HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McGregor, C. G. Articles by Corris, P. A. Search for Related Content PubMed PubMed Citation Articles by McGregor, C. G. Articles by Corris, P. A.

The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 350-354, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Early results of single lung transplantation in patients with end-stage pulmonary fibrosis

CG McGregor, JH Dark, CJ Hilton, R Freeman, ID Conacher and PA Corris
Freeman Hospital, Newcastle upon Tyne, England.

Three patients underwent single left lung transplantation for end-stage pulmonary fibrosis between June and November 1987. Preoperatively all were housebound, receiving continuous, supplemental oxygen, and their pulmonary function had deteriorated despite corticosteroid and cyclophosphamide therapy. Pulmonary preservation was by means of pulmonary arterial perfusion with modified Euro-Collins solution, 60 ml/kg, at 4 degrees C with adjunctive iloprost (synthetic prostacyclin) infusion. The heart from each donor was used successfully for transplantation. Good early graft function enabled extubation 11, 46, and 96 hours after transplantation. An omental wrap was used around the bronchial anastomosis, and bronchial healing was satisfactory in all. All patients had episodes of pulmonary rejection diagnosed by a combination of symptoms, chest x-ray infiltrates, the exclusion of pneumonitis by bronchoalveolar lavage, and prompt response to "pulse" steroid therapy. Two of the three patients had three episodes of opportunistic pulmonary infections: Herpes simplex pneumonitis, Pneumocystis carinii infection, and Aspergillus pneumonitis. The three patients were discharged from the hospital after 5, 6, and 7 1/2 weeks, respectively. The first and third patients remain alive and well, living essentially normal lives 24 and 19 months after transplantation with no evidence of arterial desaturation on exercise testing while breathing room air. The second patient had symptoms of deteriorating lung function with a progressive decline in forced expiratory volume in 1 second, vital capacity, and diffusion capacity despite repeated "pulse" therapy with combinations of methylprednisolone, antithymocyte globulin, and OKT3 (Ortho Diagnostic Systems Inc., Raritan, N.J.). An open lung biopsy specimen showed obliterative bronchiolitis, and this patient underwent orthotopic lung retransplantation, on the right side. Despite excellent early graft function and early extubation, he died of uncontrolled rejection and general debility after 3 weeks. This early experience in our center with two of three patients surviving 19 to 24 months, respectively, confirms the restoration of good pulmonary function and near normal life-style in patients with end-stage pulmonary fibrosis after single lung transplantation, as first reported by the Toronto Lung Transplant Group. We have used an alternative method of lung preservation (cold crystalloid pulmonary perfusion as opposed to topical cooling, used by the Toronto group), which provided excellent pulmonary preservation up to and beyond 4 hours' storage.(ABSTRACT TRUNCATED AT 400 WORDS)

This article has been cited by other articles:

				M. Struber, J. M. Hohlfeld, T. Kofidis, G. Warnecke, J. Niedermeyer, S. P. Sommer, and A. Haverich Surfactant function in lung transplantation after 24 hours of ischemia: Advantage of retrograde flush perfusion for preservation J. Thorac. Cardiovasc. Surg., January 1, 2002; 123(1): 98 - 103. [Abstract] [Full Text] [PDF]

				T. Wittwer, T. Wahlers, J. F. Cornelius, S. Elki, and A. Haverich Celsior solution for improvement of currently used clinical standards of lung preservation in an ex vivo rat model Eur. J. Cardiothorac. Surg., May 1, 1999; 15(5): 667 - 671. [Abstract] [Full Text] [PDF]