Single Lung Transplantation in Pulmonary Fibrosis Patients

Kim, Hae Kyoon; Lee, Doo Yun; Paik, Hoe Chae; Mun, Dong Suk; Bae, Ki Man; Han, Jae Youl; Cho, Bum Koo

Abstract

A lung transplantation in the case of idiopathic pulmonary fibrosis was performed on July 7th, 1996 by the department of Thoracic Surgery, Yonsei University Medical College. The 52 year-old male patient (having a past history of cholecystectomy, 6 years ago) suffering from severe dyspnea, progressively aggravating for last five years. On physical examinations, two surgical scars were found in his left chest wall and upper abdominal area and wheezing was auscultated in both lung fields. The pulmonary function test performed in march, 1996, revealed FVC of 1940 ml (51%) and FEV1 of 1680 ml/min (58%) and the arterial blood gas study showed pH 7.4 PaO2 43.2 mmHg, PaCO2 35.0 mmHg (room air), pH 7.4 PaO2 89.8 mmHg, PaCO2 40.8 mmHg (mask 5l/min). Through the coronary angiography, moderate degree of pulmonary hypertension and 50% stenosis of left anterior descending branch of his coronary arteries were detected. The right lung from 17 year old male under brain death was removed through a median sternotomy incision and immersed in 70 ml/Kg of preservation solution (modified Euro-collins). Preparing the recipient, the pulmonary artery was dissected and temporally ligated for 15minutes, after then, an arterial blood gas study was taken to reveal pH 6.97, PaO2 221 mmHg, PaCO2 126 mmHg (FiO2 1.0 PEEP 5 cm) and his pulmonary arterial pressure was 85/26 mmHg (when the systemic arterial pressure was 140/80 mmHg) that indicates the necessity of the cardiopulmonary bypass; extracorporeal circulation was initiated through the femoral artery and right atrium. Placing the donor lung in the ipsilateral thoracic cavity of the recipient, the bronchus was first anastomosed in an telescopic fashion (the smaller bronchus into the lumen of the larger one) using the prolene 4-0. The pulmonary artery was anastomosed by prolene 5-0 and the LA by prolene 4-0. The total ischemic time was 70 minutes and the bypass time was 145 minutes. For the postoperative immunosuppression, cyclosporin and immuran was used and 2 weeks of induction therapy with OKT3 was followed by steroid. No evidence of rejection was shown in the transbronchial lung biopsy, performed a week after the transplantation. Fever developed 3 month after and aspergillosis and CMV infection was suspected through the transbronchial lung biopsy; vigorous treatment was followed but the patient had expired after 82 days postoperative survival.