Lung volume reduction or lung transplantation for end-stage pulmonary emphysema?

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Abstract
Objective: As the waiting period for lung transplant (LT) candidates with end-stage pulmonary emphysema (COPD) continues to increase, there is a need for alternative treatments to reduce the morbidity and mortality associated with COPD. We hypothesized that lung reduction (LR) may avoid the need for subsequent LT in patients on the waiting list that are also candidates for LR. Methods: From July 1994 to December 1995, 20 patients received LR as alternative to LT. The average age was 58±7 years; 11 were males. Eighteen patients had primary COPD and two had alpha-1 antitrypsin deficiency. Eighteen LRs were thoracoscopic (two bilateral and 16 unilateral) and two were done through a median sternotomy. Results: At a follow-up of 32±4 months, 19 patients are alive (19/20=95%). Fifteen patients (15/20=75%) are currently off the LT list and doing well: FEV1 is 40±18% predicted at 2 years compared with 22.7±6% before LR (PPPConclusions: LR has the potential to offer an effective palliative alternative to LT in 75% of selected patients up to 32 months of follow-up. Widespread use of bilateral LR is anticipated to further improve the results.

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