Lung transplantation for lymphangioleiomyomatosis: the French experience

Transplantation. 2008 Aug 27;86(4):515-20. doi: 10.1097/TP.0b013e31817c15df.


Background: Lymphangioleiomyomatosis (LAM) is a rare disease, leading in some cases to end-stage respiratory failure. Lung transplantation (LT) represents a therapeutic option in advanced pulmonary LAM.

Methods: We conducted a retrospective multicenter study of 44 patients who underwent LT for LAM at 9 centers in France between 1988 and 2006.

Results: All patients were women with a mean age of 41+/-10 years at LT. There were 34 single-lung transplants and 11 bilateral transplants (one retransplantation). Prior clinical events related to LAM were present in 75% of the patients and previous thoracic surgical procedures were noted in 86.6% of cases. At the latest preoperative evaluation, 30 patients had an obstructive pattern (mean forced expiratory volume in 1 second: 26%+/-14% of predicted) and 15 had a combined restrictive and obstructive pattern, with a mean KCO=27%+/-8.8% of predicted, PaO2=52.8+/-10.4 and PaCO2=42.6+/-9.8 mm Hg. Intraoperative cardiopulmonary bypass was required in 13 cases. The length of mechanical ventilation was 7.5+/-12.8 days. The median duration of follow-up was 37 months. The 1, 2, 5, and 10 years survival rates were 79.6%, 74.4%, 64.7%, and 52.4%, respectively. Extensive pleural adhesions were found in 21 patients leading to severe intraoperative hemorrhage. Postoperative LAM-related complications were pneumothorax in the native lung in five patients, chylothorax in six, bronchial dehiscence or stenosis in seven. There were two cases of recurrence of LAM.

Conclusion: Despite a high morbidity mainly caused by previous surgical interventions and disease-related complications, LT is a satisfactory therapeutic option for end-stage respiratory failure in LAM.

MeSH terms

  • Adult
  • Biopsy
  • Female
  • France
  • Functional Laterality
  • Histocompatibility Testing
  • Humans
  • Intraoperative Complications / epidemiology
  • Lung Neoplasms / surgery*
  • Lung Transplantation / statistics & numerical data*
  • Lymphangioleiomyomatosis / physiopathology
  • Lymphangioleiomyomatosis / surgery*
  • Middle Aged
  • Oxygen Consumption
  • Respiratory Function Tests
  • Retrospective Studies
  • Smoking / epidemiology
  • Surveys and Questionnaires
  • Treatment Failure
  • Treatment Outcome