The value of ventilation scintigraphy after single lung transplantation.

BACKGROUND: A decrease in forced expiratory volume in 1 second (FEV(1)) as a diagnostic criterion for bronchiolitis obliterans syndrome (BOS) after single lung transplantation may be influenced significantly by the presence of the native lung. To quantify and to discriminate between the relative contribution of graft and native lung to the FEV(1), we retrospectively investigated the diagnostic value of combined FEV(1) measurements and ventilation scintigraphy in pulmonary dysfunction after single lung transplantation in 11 recipients with pulmonary vascular disease, 3 with obstructive lung disease, and 3 with restrictive lung disease. METHODS: We assessed function of the native lung and the graft, and subsequently calculated an adjusted grading of BOS by correcting routine FEV(1) measurements using linear interpolation of bi-annual lung ventilation scans. RESULTS: The contribution of the native lung to the total FEV(1) was slight (median, 9%) in recipients with obstructive disease compared with recipients with vascular (38%) or restrictive lung diseases (27%). Adjusted BOS grading was not useful in patients with obstructive disease. In the other patient groups, the onset of adjusted BOS Grade 1 and standard BOS Grade 1 was at a median of 220 days (range, 127-1146 days) and 836 days (184-3065 days), respectively. CONCLUSION: Ventilation scintigraphy is a useful adjunct in the (early) diagnosis of BOS in recipients of single lung transplants who have vascular and restrictive lung diseases.

Long-term quality of life in patients surviving at least 55 months after lung transplantation.

The aim of this study was to examine the long-term effect of lung transplantation on Health Related Quality of Life by studying 28 patients who survived at least 55 months after lung transplantation. Measures included the Nottingham Health Profile, questions concerning lung-specific problems, the State-Trait Anxiety Inventory, the Self-rating Depression Scale, the Index of Well-Being, the Karnofsky performance index, and questions concerning activities of daily life. Furthermore, comorbid conditions were measured. Before transplantation patients reported restrictions on almost all quality of life measures. Until approximately 43 months after transplantation there were significant improvements on most dimensions of the Nottingham Health Profile and more patients could walk without dyspnea. Significant improvements occurred with regard to the levels of anxiety, depression, and well being, and the scores on the Karnofsky performance index improved. Activities of daily life could be performed without help by most patients. After approximately 43 months patients experienced more dyspnea, anxiety, depression, and a lower level of well being. The number of patients suffering from a decrease of kidney function, drug treated hyperlipidemia, insulin dependent diabetes mellitus and bronchiolitis obliterans syndrome increased. It may be concluded that patients experience a stable and better overall quality of life after transplantation. Long-term after lung transplantation patients experience a decline on several dimensions of quality of life, which may be explained by an increase of comorbid conditions and Bronchiolitis Obliterans Syndrome.

Bronchiolar airflow impairment after lung transplantation: an early and common manifestation.

BACKGROUND: Bronchiolitis obliterans syndrome (BOS) is the major limitation to long-term survival after lung transplantation (LT). In this study we investigate the extent and frequency of airflow limitation after LT and its value for the diagnosis of BOS. METHODS: Flow-volume measurements were analyzed retrospectively in 36 recipients of a bilateral LT, with a median follow-up of 32.9 months. The prevalence and onset of a decline of FEV(1), FEF(25), FEF(50), FEF(75) and MMEF(75/25) were evaluated and subsequently related to the occurrence of Grade 1 BOS. RESULTS: Grade 1 BOS was diagnosed in 16 recipients at a median of 218 (range 88 to 1,007) days after LT. A persistent and significant decrease in FEV(1), FEF(25), FEF(50), FEF(75) and MMEF(75/25) was observed in 23, 24, 30, 32 and 29 patients, respectively. In those patients developing BOS during follow-up this decrease was determined at 147 (55 to 657), 130 (78 to 932), 110 (21 to 573), 103 (32 to 657) and 121 (32 to 657) days after LT (p < 0.0005), respectively. The respective predictive values of these parameters for the occurrence of Grade 1 BOS (within 120 days) were 88%, 60%, 50%, 35% and 41%. CONCLUSION: Bronchiolar dysfunction is a common and early finding after LT. The decrease of FEV(1) in BOS is often preceded by a decrease of bronchial airflow. Airflow markers may be used as an early warning sign for the development of BOS, although their predictive values are moderate.