Bronchoscopic lung volume reduction as a bridge to lung transplantation in patients with chronic obstructive pulmonary disease.

BACKGROUND Chronic obstructive pulmonary disease (COPD) is the leading indication for lung transplantation; however, these patients rarely gain priority on the waiting list until very late. The clinical status can be improved by surgical lung volume reduction; this procedure, although carries significant morbidity, has been repeatedly advocated as a bridge. Recently, bronchoscopic lung volume reduction (BLVR) has been proposed to improve functional parameters in patients with emphysema; however, it has never been reported as a bridge to lung transplantation so far. METHODS We hereby report our experience with BLVR as a bridge to lung transplantation in four patients (males, mean age 51 years). RESULTS All patients underwent unilateral BLVR (two right upper lobe (RUL), one right lower lobe (RLL), and one left upper lobe (LUL); mean 3.5 valves per patient). No morbidity and mortality were observed. Three out of the four patients successfully reached transplantation after 6, 7, and 6 months, respectively. Two patients received single-lung transplantation and one sequential double-lung transplantation. The fourth patient died of respiratory failure 13 months after valve placement. BLVR was able to reduce the residual volume and improve the 6-min walking test and Medical Research Council (MRC) score. CONCLUSIONS BLVR allowed to improve the functional status and quality of life of these patients. In a selected group of COPD patients awaiting lung transplantation, the reported short- to medium-term objective improvement may play an important role to ameliorate the clinical status and reach the time of surgery.