ABSTRACT
<p><b>OBJECTIVE</b>To investigate the selection of recipients, operative technique, and perioperative management of lung transplantation for silicosis.</p><p><b>METHODS</b>Lung transplantations (LTx) were performed for five end-stage silicosis in our hospital who were diagnosed in accordance with recommendations of the local Prophylactic Therapeutic Institution for Occupational Diseases. The chest roentgenogram and high resolution CT showed somewhat pulmonary interstitial fibrosis, pulmonary emphysema and massive opacities. The mean pulmonary artery pressure (mPAP) was > 30mmHg, NYHA III or IV. Two patients received thoracic surgery prior to LTx, one patient was ventilator-dependent. One patient received bilateral sequence lung transplantation (BSLT) under extracorporeal membrane oxygenation (ECMO) support. Four patients received single lung transplantation (SLT), 3 under ECMO support.</p><p><b>RESULTS</b>Patient five died of multiple organ failure on postoperative day 8, the remaining four patients were discharged from hospital. During follow up, patient three died of severe infection 7 month postoperatively, the remaining three patients were alive for 5 years, 3 years and 2 years respectively, and lived good quality of life, especially with lower mPAP and improved lung function. Although our patients suffered low-grade chronic rejection with the manifestation of bronchiolitis obliterative syndrome (BOS).</p><p><b>CONCLUSION</b>Lung transplantation is a viable option for patients with end-stage silicosis, providing acceptable quality of life and survival. Both SLT and BSLT are satisfactory approach for end-stage silicosis,and long-term survival requires further investigations.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Follow-Up Studies , Lung Transplantation , Silicosis , General Surgery , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To investigate the operation of lung transplantation for end-stage emphysema.</p><p><b>METHODS</b>From September 2002 to February 2005, 9 patients with chronic obstructive pulmonary disease (COPD) underwent lung transplantation. The types of surgery included single lung transplantation in 2 patients, lung transplantation with asynchronous contralateral lung volume reduction (one week later) in 1, single lung transplantation with synchronized contralateral lung volume reduction in 4, and bilateral sequential lung transplantation without cardiopulmonary bypass in 2.</p><p><b>RESULTS</b>The volume of chest drainage was more than 2000 ml at the first postoperative day in 2 patients, one was reoperated for hemostasis and another was successfully responded to conservative therapy. The ventilation time was ranged from 3 to 22 days postoperatively. Two patients were received tracheotomy. Seven patients achieved good results, two of them had returned to work, and 1 patient had lived for 30 months. One patient was died of severe acute rejection (4A) at 15th postoperative day and 1 succumbed to multisystem organ failure due to severe bacterial infection combine fungal infection.</p><p><b>CONCLUSION</b>End-stage emphysema is an indication for single lung transplantation. Single lung transplantation with contralateral lung volume reduction is a good way to utilize donor. If patient suffered from infection, double-lung transplantation should be considered first.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Lung Transplantation , Methods , Pneumonectomy , Methods , Pulmonary Disease, Chronic Obstructive , General Surgery , Pulmonary Emphysema , General Surgery , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To evaluate operative technique, patient selection and perioperative management of single-lung transplantation for a patients with end-stage emphysema.</p><p><b>METHODS</b>A 56-year-old patient with end-stage emphysema underwent left-lung transplantation on September 28, 2002. The surgical technique used was similar to that mentioned in the literature. The donor lung was perfused by LPD solution with a cold ischemic time of 260 minutes. Cardiopulmonary bypass was not performed.</p><p><b>RESULTS</b>The patient weaned from a ventilator at the 93th hour after operation. Immunosuppressants included cyclosporine, mycophenolate mofetil and corticosteroid. Acute rejection occurred on the ninth day after operation and was cured by bolus methylprednisolone given intravenously. Lung function was improved significantly and the patient was discharged from the hospital on the 47th day after operation.</p><p><b>CONCLUSION</b>Single-lung transplantation for patients with end-stage emphysema is effective for long-term improvement of pulmonary function.</p>