A 41-year-old man complained of progressive dyspnea for 5 years. Six months before his admission to our institution, he had a history of using heroin over 11 years, initial inhalation for 8 years and later injection for 3 years. His CT scans (Fig 1A) demonstrated the severe bilateral emphysema. The forced expiratory volume in 1 second (FEV1) was 0.37 L (10% of the predictive value). After discussion with the local ethics committee, he was considered for lung transplantation. During the 2 month period on waiting list for suitable lung, several times of blood tests were performed and the result demonstrated the negative heroin administration. On April 17, 2006, he underwent right single-lung transplantation with the permission from the local ethics committee and the consent of the patient. His procedure was similar with other LTs. The right pneumonectomy was then performed. The bronchial anastomosis was performed by using a running 4-0 prolene suture for the posterior membranous wall, and interrupted horizontal mattress sutures with 4-0 monocryl for the cartilaginous wall. The pulmonary artery and left atrial anastomoses were all performed by using a running 4-0 prolene suture.

Heroin abuse typically produces well-recognized syndromes associated nearly all the organs of the body. The relations between heroin addiction and the impaired lung function were often reported (2,3). Candidates with the history of substance addiction are not absolutely ineligible for LT if they have been free of the substance for more than 6 months.