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A7253 - Effect of Bilateral Lung Transplantation on Excessive Dynamic Airway Collapse
Author Block: J. Singh1, D. Sese2, C. J. Lehr3, B. M. Pichurko4, A. C. Mehta5; 1Internal Medicine, Cleveland Clinic, Cleveland, OH, United States, 2Internal Medicine, Cleveland Clinic Akron General, Akron, OH, United States, 3Cleveland Clinic, Cleveland, OH, United States, 4Respiratory Inst, Cleveland Clinic Foundation, Cleveland, OH, United States, 5Respiratory Institute, Cleveland Clinic Main Campus, Cleveland, OH, United States.
Rationale: Excessive dynamic airway collapse (EDAC) is defined as greater than or equal to 50% decrease in anterior-posterior diameter of the central airways during expiration. EDAC occurs due to bulging of the pars-membranacea. It is shown to be associated with significant morbidity including respiratory failure. It has been hypothesized that EDAC may limit the benefits of lung transplantation in patients with COPD. We conducted this study to find the effect of bilateral lung transplantation on EDAC in patients with history of COPD. Methods: A retrospective chart review was performed to identify patients who underwent bilateral lung transplantation from Dec 2011 to Dec 2014. Cases with concomitant presence of COPD and EDAC before transplantation were selected. Data was gathered for demographics, age at the time transplantation, type of lung transplantation (sequential vs en-bloc), and survival after transplantation. Pre and post-transplant pulmonary function tests, flow-volume (FV) loops, computed tomography (CT) of the chest, and flexible bronchoscopies were studied. Results: 34 patients underwent bilateral lung transplantation from December 2011 to December 2014. 28 had diagnosis of COPD. Out of 28, 8 were found to have EDAC prior to the transplant. Mean age at transplantation was 60.3 years. 7 had sequential and 1 had en-bloc double lung transplant. 7 out of 8 patients were alive at the time of study. Post-transplant, mean predicted FEV1/FVC ratio increased from 37% to 117% and mean predicted FEV1 increased from 20% to 61%. Pre-transplant FV loops showed inflection point in 7 out of 8 patients. Post-transplant, there was resolution of inflection point in all 7 patients. 7 patients showed resolution of EDAC on expiratory CT chest and 1 patient did not have post-transplant CT chest. All 8 showed no EDAC on post-transplant surveillance bronchoscopy. Conclusions: Bilateral lung transplantation leads to resolution of EDAC in the COPD patient population. There is significant improvement in mean FEV1 and FEV/FVC ratio. Flow volume loops also showed marked improvement with resolution of characteristic inflection point. EDAC should not be considered as a contraindication to bilateral lung transplantation. Symptomatic EDAC can be an indication for bilateral lung transplantation and further studies are required to strengthen this potential use.