Regional Ventilation and Perfusion after Lung Transplantation in Patients with Emphysema

Serial 133Xe ventilation and perfusion scans were done on two patients who underwent left-lung transplantation because of severe emphysema associated with alpha1 antitrypsin deficiency. In both, perfusion of the implants increased to nearly 70 per cent of total and was accompanied by a decrease in ventilation and volume to about 30 per cent of total. Under these circumstances the implants functioned largely as physiologic shunts. The remaining emphysematous lung increased in volume and received most of the ventilation but very little of the total perfusion. Patients with emphysema thus may be poor candidates for lung transplantation because the high vascular resistance and static compliance of the remaining emphysematous lung predispose it to further hypoperfusion and hyperinflation.