Abstract
Background: Following successful lung transplantation, most of the lung perfusion, as well as ventilation, is shifted towards the transplanted lung. We investigated the changes in perfusion during exercise in lung transplant recipients. Patients and Methods: Twelve patients were included in the study. Six patients had emphysema and 6 patients had idiopathic pulmonary fibrosis (IPF). Patients underwent two upright lung perfusion scans: the first at rest and the second during a maximal cardiopulmonary exercise test. Lung perfusion was assessed in each lung and regionally. Results: At rest, patients with emphysema had 83.3 ± 8 % of total perfusion to the transplanted side and 16.7 ± 8 % to the native lung, while in the IPF patients, it was 68.7 ± 12 and 32.7 ± 10 %, respectively (p = 0.028). At peak exercise, perfusion shifted from the transplanted lung to the native lung (p = 0.0095) both in emphysema and IPF patients. Conclusions: Following successful lung transplantation, most of the perfusion is directed towards the transplanted lung. During exercise, there was a small but significant shift towards the native lung. These findings highlighted the important role of the native lung during maximal exercise.
Key words
cardiovascular surgery - heart and lung transplantation - thoracic surgery
References
1
Kaiser L R, Cooper J D, Trulock E P, Pasque M K, Triantafillo A, Haydock D.
The evolution of single lung transplantation for emphysema. The Washington University Lung Transplant Group.
J Thorac Cardiovasc Surg.
1991;
102
333-339
2
Grossman R F, Frost A, Zamel N.
Results of single lung transplantation for bilateral pulmonary fibrosis. The Toronto Lung Transplant Group.
N Eng J Med.
1990;
322
727-733
3
Pasque M K, Trulock E P, Kaiser L R, Cooper J D.
Single lung transplantation for pulmonary hypertension. Three-month hemodynamic follow-up.
Circul.
1991;
84
2275-2279
4
Bates D V.
The other lung.
N Engl J Med.
1970;
282
277-279
5
Ross D J, Waters P F, Waxman A D, Koerner S K, Mohsenifar Z.
Regional distribution of lung perfusion and ventilation at rest and during steady-state exercise after unilateral lung transplantation.
Chest.
1993;
104
130-135
6
Miyoshi S, Trulock E P, Schaefers H J, Hsieh C M, Patterson G A, Cooper J D.
Cardiopulmonary exercise testing after single and double lung transplantation.
Chest.
1990;
97
1130-1136
7
Mohsenifar Z, Ross M D, Waxman A, Goldbach P, Koerner S K.
Changes in distribution of lung perfusion and ventilation at rest and during maximal exercise.
Chest.
1985;
87
359-362
8
Gibbons W J, Levine S M, Bryan C L, Segarra J, Calhoon J H, Trinkle J K, Jenkinson S G.
Cardiopulmonary exercise responses after single lung transplantation for severe obstructive lung disease.
Chest.
1991;
100
106-111
9
American Thoracic Society .
Standardization of spirometry - 1987 update.
Am Rev Respir Dis.
1987;
136
1285-1298
10 Wasserman K, Hanse J E, Sve D Y, Whipp B J. Principles of Exercise Determination and Interpretation. Philadelphia; Lea & Febiger 1987: 1-57
11
Sundaresan S, Trachiotis, Aoe M, Patterson G, Cooper J.
Donor lung procurement: assessment and operative technique.
Ann Thorac Surg.
1993;
56
1409-1413
12
Meyers B, Patterson G.
Bilateral lung transplantation.
Opin Technol Thorac Cardiovasc Surg.
1999;
4
162-175
13
Theodore J, Morris A J, Burke C M, Glanville A R, Van Kessel A, Baldwin I C.
Cardiopulmonary exercise at maximal tolerable constant work rate exercise following human heart-lung transplantation.
Chest.
1987;
92
433-439
14
Kuni C C, Ducret R P, Nakhleh R E, Boudreau R J.
Reverse mismatch between perfusion and aerosol ventilation in transplanted lungs.
Clin Nucl Med.
1993;
18
313-317
15
Kramer M R, Marshall S E, McDougall M.
The distribution of ventilation and perfusion after single lung transplantation in patients with pulmonary fibrosis and pulmonary hypertension.
Transplant Proc.
1991;
23
1215-1216
16
Hardoff R, Steinmetz A P, Krausz Y, Bar-Sever Z, Liani M, Kramer M R.
The prognostic value of perfusion lung scintigraphy in patients with single lung transplantation for emphysema and pulmonary fibrosis.
J Nucl Medic.
2000;
41
1771-1776
17
Fink G, Lebzelter J, Blau C, Klainman E, Aravot D, Kramer M R.
The sky is the limit: exercise capacity 10 years post-heart-lung transplantation.
Transplant Proc.
2000;
32
733-734
MD Mordechai R. Kramer
Pulmonary Institute Rabin Medical Center Beilinson Campus
Petach Tikwa, 49100
Israel
Phone: + 9 72 39 37 72 21
Fax: + 9 72 39 24 20 91
Email: davids3@clalit.org.il