Native lung hyperinflation after single lung transplantation – case report and literature review

Abstract

Introduction: Single lung transplantation (SLuTx) is a challenging operation for patients with end-stage chronic pulmonary diseases. After surgery, native lung hyperinflation (NLH) and a mediastinal shift may develop, which changes the anatomical position of the lungs and heart and may lead to graft compression. Aim: We present a case report of a patient who developed NLH after SLuTx. We discuss the treatment methods and compare the outcomes with other case reports and analysis from world literature. Case study: A 56-year-old female patient was diagnosed with end-stage chronic obstructive pulmonary disease (FEV1 < 30%) and qualified for right SLuTx. After the procedure, spirometry revealed gradual loss in FEV1. Radiological images confirmed NLH and compression of the graft. Therefore, a native lung pneumonectomy was performed with positive outcomes. Results and discussion: NLH is a known complication of SLuTx. Typically, lung volume reduction surgery is performed to reduce the compression and a pneumonectomy is a rare treatment, even in centres with extensive experience with SLuTx. Conclusions: Despite SLuTx being a common approach in many pulmonary diseases, NLH should be always taken into consideration. Hyperinflation could cause a dangerous loss of respiratory efficiency and require invasive surgeries for lung transplant recipients.