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Recurrence of Pulmonary Emphysema in an -1 Proteinase Inhibitor-deficient Lung Transplant Recipient

Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy; Unité Inserm 492 et Service de Physiologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France

Correspondence and requests for reprints should be addressed to Hervé Mal, M.D., Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, 100 Bd Gen Leclerc 92110, Clichy, France. E-mail: herve.mal{at}bjn.ap-hop-paris.fr

Several types of primary disease may recur after lung transplantation, but recurrence of pulmonary emphysema has so far never been published. We report the case of a 49-year-old white male who underwent single lung transplantation for emphysema related to -1 antitrypsin deficiency and to superimposed smoking. The postoperative course was complicated by several rejection episodes. Subsequently, the patient remained stable without evidence of graft dysfunction for more than 10 years, but he resumed light smoking at 8 years after transplant. At 11 years after transplant, although the patient was still asymptomatic and had a stable lung function, recurrence of emphysema on the grafted side was diagnosed on computerized tomography of the thorax. One year later, the patient began to experience a moderate decline in lung function. Two separate bronchoalveolar lavages performed after the onset of the recurrence disclosed a significant elastolytic activity related to neutrophil serine–elastase in lavage fluid. In summary, we describe a case of recurrence of pulmonary emphysema in a patient with -1 antitrypsin deficiency. The resumption of smoking has probably played a central role in the presence of elastolytic activity in lavage fluid and in the recurrence of emphysema.

Key Words: -1 proteinase inhibitor deficiency • emphysema • lung transplantation

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