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J Appl Physiol 104: 224-229, 2008. First published November 8, 2007; doi:10.1152/japplphysiol.00582.2007
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Single-breath test in lateral decubitus reflects function of single lungs grafted for interstitial lung disease

Alain Van Muylem,1 Pierre Alain Gevenois,2 Elizabeth Kallinger,3 Alexander A. Bankier,4 Christiane Knoop,1 Geert Verleden,5 and Marc Estenne1

Departments of 1Chest Medicine and 2Radiology, Erasme University Hospital, Brussels, Belgium; the 3Department of Radiology, Medical University of Vienna, Vienna, Austria; 4Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and 5Department of Chest Medicine, Gasthuisberg Hospital, Leuven, Belgium

Submitted 31 May 2007 ; accepted in final form 29 October 2007

After single-lung transplantation (SLT) for emphysema, heterogeneity of ventilation distribution in the graft can be assessed by measuring the slope of the alveolar plateau, computed from a single-breath test, performed in lateral decubitus with this lung in the nondependent position. We tested the validity of this technique in patients with SLT for interstitial lung diseases (ILD). Twelve patients with SLT for ILD, 12 nontransplanted patients with ILD, and 10 healthy control subjects performed single-breath washouts in right and left lateral decubitus; nitrogen slope (SN2) and the difference between SF6 and He slopes (SSF6-SHe) were measured between 75 and 100% of expired volume. In 10 transplant recipients, the volume of each lung was measured in both postures by computerized tomography. Slopes were unaffected by posture in normal control subjects and patients with ILD. On the other hand, SN2 and SSF6-SHe in transplant recipients were smaller with the graft in the nondependent than in the dependent position (0.366 ± 0.445 vs. 1.035 ± 0.498 for SN2; 0.094 ± 0.201 vs. 0.218 ± 0.277 for SSF6-SHe). Values of SN2 and SSF6-SHe obtained in the former position were similar to those obtained in normal controls, while values obtained in the latter position were similar to those obtained in nontransplanted patients with ILD. Computerized tomography studies with the graft in the nondependent position indicated that this lung contributed 82% of the volume expired below functional residual capacity. We conclude that, in patients with SLT for ILD, the slope of the alveolar plateau obtained with the graft in the nondependent position reflects heterogeneity of ventilation distribution in this lung.

lung transplantation; pulmonary fibrosis; distribution of ventilation


Address for reprint requests and other correspondence: M. Estenne, Chest Service, Erasme Univ. Hospital, 808, Route de Lennik, B-1070 Brussels, Belgium (e-mail: mestenne{at}ulb.ac.be)






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