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Abstract

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Article in Japanese

Case Report

A Case of bronchostenosis in the allograft after lung transplantation in pulmonary lymphangioleiomyomatosis

Chiyoko Kono1) 4)  Tetsuo Yamaguchi1)  Yoshihito Yamada1) 4)  Sakuo Hoshi1)  Hiroko Amano1)  Masato Minami2)  Shinichiro Miyoshi3)  Hikari Matsuda2)  Koichiro Tatsumi4)  Takayuki Kuriyama4) 

1)Department of Respiratory Medicine, Japan Railway Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo 151-8528, Japan
2)Department of Surgery, Osaka University Graduate School of Medicine, Factory of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka 565-0871, Japan
3)Department of Thoracic Surgery, Dokkyo University School of Medicine, 880 Kitakobayashi, Ooaza, Minobu-tyo, Shimotuga-gun, Tochigi 321-0293, Japan
4)Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuuou-ku, Chiba 260-8670, Japan

ABSTRACT

Pulmonary lymphangioleiomyomatosis (LAM) is a rare disease characterized by hamartomatous proliferation of abnormal smooth muscle cells in the lungs. Recently, severe LAM has been listed as an indicated disease for lung transplantation. A 34-yr-old woman with severe pulmonary cystic changes in a chest CT scan was diagnosed as having an isolated form of pulmonary LAM without genetic disorders. Despite intensive progesterone treatment, her pulmonary functions deteriorated rapidly. In January 2001, a left single-lung transplantation was performed from a cadaveric donor. The total operating time was 8 hours and 47 minutes. Total ischemic time was 5 hours and 59 minutes, which was within the permitted time limit. Except for right pneumothorax, the postoperative course was fairly good without any sign of rejection or infection in the allograft. For about two months after transplantaion, bronchostenosis occurred in the left lower lobe bronchus, and necessitated a stent placement. During the following three months, stenosis of the bronchi in the anastomotic and peripheral sites occurred repeatedly, which also necessitated stent placements or balloon dilations on each occasion. Despite all the intensive treatment, the bronchostenosis of the peripheral sites still remains and improvement of her pulmpnary functions has been poor. Moreover, a recent chest CT scan revealed a progression of the disease in the native lung. Consequently, we registered her as a candidate for transplantation of the right lung. Bronchostenosis should be kept in mind as a complication of lung transplantation.

KEYWORDS

Pulmonary lymphangioleiomyomatosis: LAM  Lung transplantation  Progesterone therapy  Bronchostenosis 

Received 平成15年4月16日

JJRS, 42(2): 170-175, 2004

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