The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.
Research Article| Volume 40, ISSUE 5, P343-350, May 2021

Download started.


Native lung complications after living-donor lobar lung transplantation

Published:January 23, 2021DOI:


      Living-donor lobar lung transplantation (LDLLT) is viable for critically ill patients in situations of donor shortage. Because it is sometimes difficult to find 2 ideal living donors with suitable graft sizes, we developed native lung-sparing procedures, including single LDLLT and native upper lobe-sparing LDLLT. This study aimed to investigate native lung complications (NLCs) in native lung-sparing LDLLT.


      Between April 2002 and March 2019, 92 LDLLTs and 124 cadaveric lung transplantations (CLTs) were performed at the Kyoto University Hospital. Our prospectively maintained database and clinical records were reviewed to compare NLCs among recipients who underwent native lung-sparing LDLLT (n = 21) with those among recipients who underwent single CLT (n = 61).


      Among 21 recipients who underwent native lung-sparing LDLLT, 11 NLCs occurred in 8 recipients. No fatal NLC was noted; however, 2 required surgical intervention. Post-transplant survival was not significantly different between native lung-sparing LDLLT recipients with NLCs and those without NLCs. The incidence of NLCs was comparable between native lung-sparing LDLLT recipients and single CLT recipients (8/21 vs 26/61, p = 0.80); however, NLCs occurred significantly later in LDLLT recipients than in CLT recipients (median: 665 vs 181.5 days after transplantation, p = 0.014).


      NLCs after native lung-sparing LDLLT had favorable outcomes. Therefore, native lung-sparing LDLLT is a useful treatment option for severely ill patients who cannot wait for CLT. However, it is important to recognize that NLCs may occur later in LDLLT than in CLT.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Heart and Lung Transplantation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Date H
        • Shiraishi T
        • Sugimoto S
        • et al.
        Outcome of living-donor lobar lung transplantation using a single donor.
        J Thorac Cardiovasc Surg. 2012; 144: 710-715
        • Aoyama A
        • Chen F
        • Minakata K
        • et al.
        Sparing native upper lobes in living-donor lobar lung transplantation: five cases from a single center.
        Am J Transplant. 2015; 15: 3202-3207
        • Date H
        • Aoyama A
        • Hijiya K
        • et al.
        Outcomes of various transplant procedures (single, sparing, inverted) in living-donor lobar lung transplantation.
        J Thorac Cardiovasc Surg. 2017; 153: 479-486
        • Takahagi A
        • Chen-Yoshikawa TF
        • Saito M
        • et al.
        Native upper lobe-sparing living-donor lobar lung transplantation maximizes respiratory function of the donor graft.
        J Heart Lung Transplant. 2019; 38: 66-72
        • Venuta F
        • Boehler A
        • Rendina EA
        • et al.
        Complications in the native lung after single lung transplantation.
        Eur J Cardiothorac Surg. 1999; 16: 54-58
        • King CS
        • Khandhar S
        • Burton N
        • et al.
        Native lung complications in single-lung transplant recipients and the role of pneumonectomy.
        J Heart Lung Transplant. 2009; 28: 851-856
        • Triplette M
        • Crothers K
        • Mahale P
        • et al.
        Risk of lung cancer in lung transplant recipients in the United States.
        Am J Transplant. 2019; 19: 1478-1490
        • Ikeda M
        • Bando T
        • Yamada T
        • et al.
        Clinical application of ET-Kyoto solution for lung transplantation.
        Surg Today. 2015; 45: 439-443
        • Date H
        • Sato M
        • Aoyama A
        • et al.
        Living-donor lobar lung transplantation provides similar survival to cadaveric lung transplantation even for very ill patients dagger.
        Eur J Cardiothorac Surg. 2015; 47 (discussion 72-3): 967-972
        • Chen F
        • Yamane M
        • Inoue M
        • et al.
        Less maintenance immunosuppression in lung transplantation following hematopoietic stem cell transplantation from the same living donor.
        Am J Transplant. 2011; 11: 1509-1516
        • Chen F
        • Chin K
        • Sato M
        • et al.
        Postoperative respiratory management in living donor lobar lung transplantation.
        Clin Transplant. 2013; 27: E383-E390
        • Kanda Y
        Investigation of the freely available easy-to-use software 'EZR' for medical statistics.
        Bone Marrow Transplant. 2013; 48: 452-458
        • Chambers DC
        • Cherikh WS
        • Harhay MO
        • et al.
        The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: thirty-sixth adult lung and heart-lung transplantation Report-2019; Focus theme: donor and recipient size match.
        J Heart Lung Transplant. 2019; 38: 1042-1055
        • Mohite PN
        • Popov AF
        • Yacoub MH
        • Simon AR
        Live related donor lobar lung transplantation recipients surviving well over a decade: still an option in times of advanced donor management.
        J Cardiothorac Surg. 2013; 8: 37
        • Shimizu H
        • Endo S
        • Natsugoe S
        • et al.
        Thoracic and cardiovascularsurgery in Japan in 2016: annual report by The Japanese Association for Thoracic Surgery.
        Gen Thorac Cardiovasc Surg. 2019; 67: 377-411
        • Horvath J
        • Dummer S
        • Loyd J
        • Walker B
        • Merrill WH
        • Frist WH.
        Infection in the transplanted and native lung after single lung transplantation.
        Chest. 1993; 104: 681-685
        • Frost AE
        • Keller CA
        • Noon GP
        • Short HD
        • Cagle PT.
        Outcome of the native lung after single lung transplant. Multiorgan Transplant Group.
        Chest. 1995; 107: 981-984
        • Speziali G
        • McDougall JC
        • Midthun DE
        • et al.
        Native lung complications after single lung transplantation for emphysema.
        Transpl Int. 1997; 10: 113-115
        • McAdams HP
        • Erasmus JJ
        • Palmer SM.
        Complications (excluding hyperinflation) involving the native lung after single-lung transplantation: incidence, radiologic features, and clinical importance.
        Radiology. 2001; 218: 233-241
        • Motoyama H
        • Chen F
        • Ohsumi A
        • et al.
        Quantitative evaluation of native lung hyperinflation after single lung transplantation for emphysema using three-dimensional computed tomography volumetry.
        Transplant Proc. 2014; 46: 941-943
        • Miyoshi R
        • Chen-Yoshikawa TF
        • Hijiya K
        • et al.
        Significance of single lung transplantation in the current situation of severe donor shortage in Japan.
        Gen Thorac Cardiovasc Surg. 2016; 64: 93-97
        • Van Raemdonck D
        • Vos R
        • Yserbyt J
        • Decaluwe H
        • De Leyn P
        • Verleden GM.
        Lung cancer: a rare indication for, but frequent complication after lung transplantation.
        J Thorac Dis. 2016; 8: S915-S924
        • Dickson RP
        • Davis RD
        • Rea JB
        • Palmer SM.
        High frequency of bronchogenic carcinoma after single-lung transplantation.
        J Heart Lung Transplant. 2006; 25: 1297-1301
        • Date H
        Living-related lung transplantation.
        J Thorac Dis. 2017; 9: 3362-3371