Outcome of native lung in single lung transplant patients with end-stage interstitial lung disease

Purpose: From March 1988 to June 1995, 35 patients underwent single lung transplantation (SLT) for end-stage interstitial lung disease (ILD). We have evaluated the status of the non transplanted lung to assess the effect of the combination of cyclosporin-A (CSA), Imuran, and corticosteroids on the native lung. Methods: Thirty-five patients had radiographs reviewed by a thoracic radiologist. Eleven patients were excluded because they died within six months of lung transplantation. One patient was excluded because his fibrosis was found to be secondary to bronchiectasis associated with severe emphysema. Results: 9/23 patients had adequate serial CXR's and/or CT scans available for assessment. Three of 9 patients (2 IPF, 1 sarcoid) had a significant reduction in severity of the ILD by radiograph. 5/9 patients (4IPF, 1 sarcoid) had stable interstitial infiltrates in the native lung over a mean of 30 ± 8.5 months. One patient with pulmonary fibrosis had progression of his disease in the native lung. Two additional patients showed improvement on triple immunosuppression. One patient with sarcoid demonstrated diffuse granulomas and fibrosis in her resected lung at SLT. Thirteen months later, an autopsy revealed her native lung was free of granulomas. A second patient with obstructive bronchiolitis and pulmonary fibrosis had a pre-transplant FVC of 1.20 L, FEV₁ of .58 L, and was oxygen-dependent. One year post transplant, the patient developed severe chronic rejection. Four months later she autoinfarcted her SLT and V/Q scans showed no ventilation or perfusion to the transplanted lung. She was maintained on triple immunosuppression for an additional 36 months with a FVC of 1.39 L, FEV₁ of .59 L, and no exercise desaturation. She has been off immunosuppression for six months with stable pulmonary function. Conclusions: 1) 3/9 patients with end-stage interstitial pneumonitis demonstrated radiographic improvement in the native lung on triple immunosuppression; 2) One patient with progressive sarcoidosis demonstrated complete resolution of granulomas after failing treatment with high dose prednisone and cyclophosphamide; 3) One patient improved her PFTs and functional status on triple immunosuppression despite autoinfarction of the transplanted lung. Clinical Implications: These findings support the need for a pilot study to evaluate CSA, Imuran, and prednisone in patients with unresponsive interstitial lung disease.