Endoscopic treatment of native lung hyperinflation using endobronchial valves in single-lung transplant patients: a multinational experience

BackgroundHyperinflation of the native lung (NLH) is a known complication to single-lung transplantation for emphysema. The hyperinflation can lead to compression of the graft and cause respiratory failure. Endobronchial valves have been used to block airflow in specific parts of the native lung, reducing the native lung volume and relieving the graft. ObjectiveWe report short-term follow-up and safety from 14 single-lung transplant patients with NLH treated with bronchoscopic lung volume reduction using endobronchial valves. MethodsRetrospective clinical information related to endobronchial valve treatment was obtained from four centres. All patients were treated with IBVTM Valve System (Spiration, Olympus Respiratory America, Redmond, WA, USA). All patients had evidence of severe NLH with mediastinal displacement. ResultsA total of 74 IBV valves were placed in 14 patients, with an average of 5.3 (range 2-10). Five patients had two procedures with staged treatment. Eleven patients reported symptom relief, and nine had lung function improvements. There was a significant increase in forced expiratory volume in 1s of 9% (P=0.013) and forced vital capacity of 15% (P=0.034) within the first months after treatment. There were no reported device-related adverse events nor reports of migration. Two patients had pneumothorax. One patient had pneumonia in the location of the valve placement, and another had infection within days. Three other patients were hospitalised with infection 2 months after treatment. ConclusionsTreating NLH with IBV endobronchial valves leads to clinical improvement in the majority of patients, and the treatment has an acceptable safety.