Use of Endobronchial Valves for Native Lung Hyperinflation Associated With Respiratory Failure in a Single-Lung Transplant Recipient for Emphysema* Maria M. Crespo, MD; Bruce A. Johnson, MD; Kenneth R. McCurry, MD; Rodney J. Landreneau, MD, FCCP; and Frank C. Sciurba, MD, FCCP Emphysema is a common indication for adult pulmonary transplantation. Double-lung transplan- tation is increasingly the preferred approach because severe posttransplant native lung hyper- inflation (NLH) following single-lung transplantation may compromise allograft lung function. We describe successful emergency use of bronchoscopic lung volume reduction using endobron- chial valves (EBVs) [Zephyr; Emphasys Medical; Redwood, CA] in a single-lung transplant recipient who was critically ill with ventilator dependence from complications of NLH and at excessive risk for lung volume reduction surgery or pneumonectomy. Following placement of 17 valves in all segments of the native lung, atelectasis of the native lung was accompanied by volume expansion of the allograft. Immediately following valve placement, peak airway pressure decreased and alveolar ventilation increased. The patient was subsequently weaned from mechanical ventilation. This report suggests the need for clinical trials to evaluate the effective- ness of EBVs in single-lung transplant recipients with less critical functional impairment associated with NLH. (CHEST 2007; 131:214 –216) Key words: bronchoscopy; emphysema; endobronchial valve; lung transplant; native lung hyperinflation; volume reduction Abbreviations: BLVR  bronchoscopic lung volume reduction; EBV  endobronchial valve; NLH  native lung hyperinflation E mphysema is a common indication for adult pul- monary transplantation. Double-lung transplanta- tion is increasingly the preferred approach because severe posttransplant native lung hyperinflation (NLH) following single-lung transplantation may compromise allograft lung function. 1,2 We report successful bron- choscopic lung volume reduction (BLVR) in a single- lung transplant recipient with emphysema resulting in resolution of severe lung NLH and respiratory failure. 3 Case Report A 60-year-old man with a history of emphysema due to  1 -antitrypsin deficiency underwent right single-lung transplan- tation 7 years prior to presentation. His posttransplant course was not significant for infection or chronic rejection. His lung func- tion had been stable for 5 years; his last spirometry (FEV 1 , 56% of predicted; FVC, 54% of predicted) was performed 6 months prior to hospital admission. Immunosuppression included tacroli- mus and azathioprine without prednisone, and enzyme-replace- ment therapy with prolastin was continued. Chest radiography demonstrated NLH with a mediastinal shift. He presented to his local hospital with sudden-onset respira- tory failure requiring mechanical ventilation and was started empirically on broad-spectrum antibiotics for an infiltrate in the *From the Divisions of Pulmonary, Allergy and Critical Care Medicine (Drs. Crespo, Johnson, and Sciurba) and Cardiotho- racic Surgery (Drs. McCurry and Landreneau).University of Pittsburgh, Pittsburgh, PA. Drs. Crespo, Landreneau, and Sciurba are investigators in the Endobronchial Valve for Emphysema Palliation Trial (Emphasys Medical, Inc). Drs. Johnson and McCurry have no conflicts of interest to disclose. Manuscript received May 4, 2006; revision accepted July 7, 2006. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal. org/misc/reprints.shtml). Correspondence to: Maria M. Crespo, MD, University of Pittsburgh Medical Center, Division of Pulmonary, Allergy and, Critical Care Medicine, NW 628 Montefiore University Hospital, 3459 Fifth Ave, Pittsburgh, PA 15213; e-mail: crespomm@upmc.edu DOI: 10.1378/chest.06-1171 Original Research INTERVENTIONAL PULMONOLOGY 214 Original Research