Published online Jul 26, 2020. doi: 10.12998/wjcc.v8.i14.3031
Peer-review started: March 19, 2020
First decision: April 22, 2020
Revised: May 25, 2020
Accepted: July 16, 2020
Article in press: July 16, 2020
Published online: July 26, 2020
End-stage chronic obstructive pulmonary disease (COPD) is one of the common lung diseases referred for lung transplantation. According to the international society of heart and lung transplantation, 30% of all lung transplantations are carried out for COPD alone. When compared to bilateral lung transplant, single-lung transplant (SLT) has similar short-term and medium-term results for COPD. For patients with severe upper lobe predominant emphysema, lung volume reduction surgery is an excellent alternative which results in improvement in functional status and long-term mortality. In 2018, endobronchial valves were approved by the Food and Drug Administration for severe upper lobe predominant emphysema as they demonstrated improvement in lung function, exercise capacity, and quality of life. However, the role of endobronchial valves in native lung emphysema in SLT patients has not been studied.
We describe an unusual case of severe emphysema who underwent a successful SLT 15 years ago and had gradual worsening of lung function suggestive of chronic lung allograft dysfunction. However, her lung function improved significantly after a spontaneous pneumothorax of the native lung resulting in auto-deflation of large bullae.
This case highlights the clinical significance of native lung hyperinflation in single lung transplant recipient and how spontaneous decompression due to pneumothorax led to clinical improvement in our patient.
Core tip: Native lung hyperinflation can lead to significant transplanted lung dysfunction and worsening of clinical symptoms. While lung volume reduction surgery has been identified as an approach to improve quality of life in patient with severe upper-lobe predominant emphysema, its benefits in single lung transplant patient is limited to case reports and small retrospective studies. No prior case has been described of an auto-lung volume reduction of native lung in single lung transplant patient. In our patient, a spontaneous pneumothorax in the emphysematous native lung led to automatic lung volume reduction and significant clinical improvement. This case highlights the importance of identifying appropriate patient selection for lung volume reduction surgery when chronic lung allograft dysfunction has been ruled out in transplanted lung and patient has significant symptom burden and evidence of native lung hyperinflation.