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 Citation Map 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 McDougall, J. C. Search for Related Content PubMed PubMed Citation Articles by McGregor, C. G. Articles by McDougall, J. C.

The Annals of Thoracic Surgery, Vol 57, 1513-1520, Copyright © 1994 by The Society of Thoracic Surgeons

ARTICLES

Evolving strategies in lung transplantation for emphysema

CG McGregor, RC Daly, SG Peters, DE Midthun, JP Scott, MS Allen, HD Tazelaar, MR Keating, RC Walker and JC McDougall
Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905.

Evolving strategies of pulmonary preservation, bronchial revascularization, immunosuppression, and infectious disease management were used in 15 initial consecutive patients undergoing lung transplantation for emphysema. There were 10 women and 5 men with a mean age of 49 years (range, 36 to 60 years). All patients required supplemental oxygen therapy. One bilateral, 9 left, and 5 right transplantations were performed. Mean preoperative forced expiratory volume in 1 second and total lung capacity were 16% and 146%, respectively, of predicted. Quadruple drug immunosuppression was used. Actuarial 1-year survival in this initial series is 93.3% +/- 6.4% (Kaplan-Meier) with one early cardiac death at day 71. Mean forced expiratory volume in 1 second and diffusing capacity for carbon monoxide at discharge were 43% and 62%, respectively, of predicted. Rehabilitation has been excellent, and all survivors are active and free of supplemental oxygen. During the study, the following treatment strategies have evolved: (1) University of Wisconsin solution has replaced Euro-Collins' solution for pulmonary preservation; (2) direct bronchial revascularization with the internal thoracic artery now is used; (3) an algorithm-based variable dose OKT3 induction regimen has resulted in a major reduction in dosage; and (4) infectious disease management focuses on the prophylaxis of cytomegalovirus and fungal infection using prolonged ganciclovir and early itraconazole therapy as well as the avoidance of Epstein-Barr virus mismatches. Single-lung transplantation for emphysema has excellent early results with continuing evolving management strategies.

This article has been cited by other articles:

				S. M. Fiser, C. G. Tribble, A. K. Kaza, S. M. Long, J. A. Kern, D. C. Cassada, J. Linden, J. Rieger, V. E. Laubach, A. Matisoff, et al. Adenosine A2A receptor activation decreases reperfusion injury associated with high-flow reperfusion J. Thorac. Cardiovasc. Surg., November 1, 2002; 124(5): 973 - 978. [Abstract] [Full Text] [PDF]

				J Dakin and M Griffiths The pulmonary physician in critical care 1: Pulmonary investigations for acute respiratory failure Thorax, January 1, 2002; 57(1): 79 - 85. [Abstract] [Full Text] [PDF]

				S. M. Fiser, C. G. Tribble, S. M. Long, A. K. Kaza, J. T. Cope, V. E. Laubach, J. A. Kern, and I. L. Kron Lung transplant reperfusion injury involves pulmonary macrophages and circulating leukocytes in a biphasic response J. Thorac. Cardiovasc. Surg., June 1, 2001; 121(6): 1069 - 1075. [Abstract] [Full Text] [PDF]

				S. M. Fiser, C. G. Tribble, S. M. Long, A. K. Kaza, J. A. Kern, and I. L. Kron Pulmonary macrophages are involved in reperfusion injury after lung transplantation Ann. Thorac. Surg., April 1, 2001; 71(4): 1134 - 1139. [Abstract] [Full Text] [PDF]

				R. C Cook, G. Fradet, D. Ostrow, and B. Nelems Lung Volume Reduction Surgery Following Single-Lung Transplantation Asian Cardiovasc Thorac Ann, September 1, 1999; 7(3): 221 - 224. [Abstract] [Full Text] [PDF]

				M. A. Norgaard, P. S. Olsen, U. G. Svendsen, and G. Pettersson Revascularization of the Bronchial Arteries in Lung Transplantation: An Overview Ann. Thorac. Surg., October 1, 1996; 62(4): 1215 - 1221. [Abstract] [Full Text]

				P. Aarnio, H. Schersten, H. D. Tazelaar, V. M. Miller, and C. G. A. McGregor EFFECTS OF ACUTE REJECTION AND ANTIREJECTION THERAPY ON ARTERIES AND VEINS FROM CANINE SINGLE LUNG ALLOGRAFTS J. Thorac. Cardiovasc. Surg., June 1, 1996; 111(6): 1219 - 1229. [Abstract] [Full Text]