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Introduction: lung volume reduction surgery (LVRS) has been applied to improve lung function in patients with emphysema and can also be considered as a "bridge" to lung tranpant (LTx) in selected cases. LVRS can also be applied to treat the contralateral lung in patients undergoing a single LTx. An additional application of LVRS lies in modification of donor lungs to improve size matching. Methods: We retrospectively reviewed the records of those patients who underwent LVRS followed by lung transplant (bridge), patients who underwent simultaneous SLTx and LVRS of native lung and patients who had LVRS of the donor lung looking specifically at early complications, intubation time, SICU and hospital stay. Results: The period of review was from June/95 to Sept/98. We found 3 patients with emphysema who underwent LVRS prior to BLTx, median age 65 (range: 57-67). The procedure was done 2 years before LTx in 2 patients and 3 years LTx in the other one. In the second group 2 patients who underwent left SLTx+LVRS on the right lung and one with LVRS on the left with right SLTx. Median age 56 (range: 57-62). Finally, 8 patients underwent BLTx plus LVRS on the donor lungs. Median age was 35.5(range: 20-58). Underlying diseases were Eisenmenger's syndrome (AP window) (1) emphysema (1) CF (3) bronchiectasis (1) pulmonary fibrosis (1) bronchiolitis obliterans (1). Intubation time, SICU time and hospital stay were not different from those of the general lung transplant population although the surgery in these patients with prior LVRS was technically more difficult. There were no early complications post LTx related to the LVRS. In the last group there were 2 deaths due to sepsis in recipients with Bronchiectasis and CF (B. cepacia). Conclusion: LVRS is a technique that can be applied pre, concurrent to, and post transplantation. It can be used as a bridge or alternate to transplant in selected patients, to improve size matching of donor organs, and post-transplantation to improve the graft physiology.