Effect of volume reduction on lung transplant timing and selection for chronic obstructive pulmonary disease Joseph E. Bavaria, MD, Alberto Pochettino,

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Presentation transcript:

Effect of volume reduction on lung transplant timing and selection for chronic obstructive pulmonary disease Joseph E. Bavaria, MD, Alberto Pochettino, MD, Robert M. Kotloff, MD, Bruce R. Rosengard, MD, Peter M. Wahl, BA, J. Roberts, MD, Harold I. Palevsky, MD, Larry R. Kaiser, MD The Journal of Thoracic and Cardiovascular Surgery Volume 115, Issue 1, Pages 9-18 (January 1998) DOI: 10.1016/S0022-5223(98)70437-4 Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 1 Results/patient flow from prospective LVR/transplant algorithm. Note: three patients underwent transplantation; two of four late failures did not meet ongoing criteria for transplant; two of six patients with primary failure were subsequently deactivated from the list for noncompliance. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 9-18DOI: (10.1016/S0022-5223(98)70437-4) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 2 Initial FEV1 response (n = 28): primary successes versus primary failures. This graph shows the results in FEV1 after LVR of the primary success group and primary failure group. Patients with primary successes were then placed on status 7. Those with primary failure were kept on the transplant list. p Value shown refers to the difference in percent change in FEV1. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 9-18DOI: (10.1016/S0022-5223(98)70437-4) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 3 Intermediate-term pulmonary function decline in primary success cohort. This graph demonstrates the decline in pulmonary function over a 12-month period in patients with a primary LVR success. Four of 21 primary successes were subsequent late failures. Note that these four patients (late failures) had rapid early declines in FEV1. p Value shown represents the difference in rate of decline between the continued successes and the late failures, from the point at which peak FEV1 was reached (mean time = 4.0 months) until most recent testing (mean time = 12.0 months). Two of four with late failure were put back on the list and underwent transplantation; the remaining two (mean = 26 months after LVR) were subsequently considered poor candidates for transplantation because of age (both 65 years old at present), recently acquired heart failure, and worsening osteoporosis. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 9-18DOI: (10.1016/S0022-5223(98)70437-4) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 4 Percentage of evaluated patients with COPD subsequently listed for lung transplantation only. Excludes both (1) patients with a standard contraindication to transplant and (2) those placed on the “prospective” LVR management algorithm. Note: Lung transplant program evaluations initiated in July 1991. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 9-18DOI: (10.1016/S0022-5223(98)70437-4) Copyright © 1998 Mosby, Inc. Terms and Conditions

Fig. 5 Changes in composition of the lung transplant list over time. Note decreasing percentage of COPD and pulmonary hypertension diagnoses and the increased percentages of interstitial pulmonary fibrosis, cystic fibrosis, and other complex end-stage lung disease. The first arrow shows when LVR Prospective Management Algorithm was initiated; the second arrow shows when in-house IV Prostacyclin Protocol began for treatment of patients with pulmonary hypertension. NOTE: percent of patients with COPD on the list would have been even lower if medical treatment of primary pulmonary hypertension was not so successful. PH, Primary pulmonary hypertension and Eisenmenger's syndromes; IPF, interstitial pulmonary fibrosis; CF, cystic fibrosis. Complex/Other, pulmonary alveolar microlithiasis, bronchiolitis obliterans, sarcoidosis, lymphangioleiomyomatosis, scleroderma, bronchiectasis, Noonan's syndrome, chronic pulmonary embolism, pulmonary venous obstructive disease, asthma, Kartagener's syndrome, berylliosis, chronic granulomatous disease, and silicosis. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 9-18DOI: (10.1016/S0022-5223(98)70437-4) Copyright © 1998 Mosby, Inc. Terms and Conditions